Medical data encryption for communication over a vulnerable system

ABSTRACT

A method for securing patient medical information for communication over a potentially vulnerable system includes separating patient&#39;s medical file into a demographics layer and a data layer, separately encrypting the demographic layer and data layer using different encryption keys, and providing servers in a communication and processing system with a decryption key for the layer processed by such server. Medical file data may be separated into more than two layers. Users accessing the system are authenticated using standard techniques. By separately encrypting different parts of a patient medical record, processing and communication of patient medical files by intermediary servers is enabled without risking disclosure of sensitive patient information if such servers are compromised.

RELATED APPLICATIONS

The present application is a continuation of U.S. patent applicationSer. No. 11/778,751 (issuing as U.S. Pat. No. 7,974,924), which claimsthe benefit of priority to U.S. Provisional Application No. 60/831,820,filed Jul. 19, 2006, the entire contents of both of which are herebyincorporated by reference. The present application is also related toU.S. patent application Ser. No. 11/778,744, entitled “System For RemoteReview Of Clinical Data” and to U.S. patent application Ser. No.11/778,731, entitled “Method For Remote Review Of Clinical Data,” bothof which were filed contemporaneous with U.S. patent application Ser.No. 11/778,751, the entire contents of both of which are herebyincorporated by reference.

FIELD OF THE INVENTION

The present invention relates generally to medical information systems,and more particularly to a system, method and apparatus for accessingpatient data remotely on a handheld device and reviewing criticalpatient data to reach informed clinical decisions.

BACKGROUND

With the deployment of medical communication systems which transfer datafrom within the hospital to physician-carried mobile communicationdevices via public cell phone and other networks, the need forencrypting such sensitive data will become significant. In applicationswhere patient medical data has to be further stored or processed outsidethe hospital, such as on a public or shared server or a cell phonesystem file server, there will be a need for file handling methods whichpreclude accessing or reassembling the patient's data other than by apassword protected physician handheld.

While encryption and authentication technologies are currentlyavailable, such technologies only allow transmission of data from theencryption point to the decryption point, with no further protectionoffered post decryption. In instances, where data needs to be decryptedat an intermediate point for further processing (such as for messagedelivery or routing purposes), standard encryption techniques are notsufficient.

Current laws applicable to medical data in the USA, such as HIPAA,require that any server storing patient medical data be secure withaccess limitations and written agreements to control access to the data.However, in wide implementations, such controls, although systematicallypossible, are not fool-proof. A fool-proof system for managing suchscenarios is required where, even if the security of a server isbreached, data located within the server cannot be reassembled intomeaningful parts.

SUMMARY

The various embodiments provide methods for processing sensitive patientmedical information in an open environment, such as a shared server,without compromising critical information, such as patient demographics.Medical data files are separated into separate parts, files or layers,with one part, file or layer encrypted such that it can only be decodedby the intended recipient, while the second part, file or layer isencrypted such that it can be decoded at an intermediary processor, suchas a server, to perform any processing required without compromising orreducing the security of the overall data. In an embodiment, a firstlayer of medical data includes the patient's identity and demographicinformation while a second includes medical information, such as medicalimages, laboratory reports or diagnostic data.

BRIEF DESCRIPTION OF DRAWINGS

The accompanying drawings, which are incorporated herein and constitutepart of this specification, illustrate exemplary embodiments of theinvention, and, together with the summary description given above andthe detailed description given below, serve to explain various featuresof the invention.

FIG. 1 is an illustration of a system for communicating medicalinformation to a physician's handheld device according to an embodiment.

FIG. 2 is a system illustration and flow diagram of a method forcommunication medical information according to an embodiment.

FIG. 3 is a system illustration and flow diagram of a method forcommunication medical information according to an embodiment.

FIG. 4 is a system illustration and flow diagram of a method forcommunication medical information according to an embodiment.

FIG. 5 is an illustration of alternatives modes of communication betweendatabases, servers, and a handheld device according to an embodiment.

FIG. 6 is an illustration of data communication between servers, and ahandheld device

FIG. 7 is a flow diagram of a method for delivering data to a handhelddevice according to an embodiment.

FIG. 8 is a flow diagram of a method for optimizing image format fordisplay on a handheld device according to an embodiment.

FIG. 9 is a flow diagram of a method for transmitting medicalinformation from an ambulance to a physician's handheld device accordingto an embodiment.

FIG. 10 is a flow diagram of a method for enabling image zoom-in andzoom-out capability on a handheld device according to an embodiment.

FIG. 11 is a flow diagram of an image processing method for enablingimage zoom-in and zoom-out capability on a handheld device according toan embodiment.

FIG. 12 is a flow diagram of image processing method for presentingmoving images on a handheld device according to an embodiment.

FIG. 13 is a flow diagram of a method for presenting moving images at aproper frame rate for presentation on a handheld device according to anembodiment.

FIG. 14 is a flow diagram of a method for providing message status andnotifications according to an embodiment.

FIG. 15 illustrates the overall operating data flow of an embodiment ofthe present invention.

FIG. 16 illustrates an embodiment of a log-in and authentication processuseful for granting user access to data.

FIG. 17 illustrates a method for generating encryption keys andcommunicating data which allow access to only parts of medical datastored on a server.

FIG. 18 is an illustration of data structures of a database usable withone or more embodiments.

FIG. 19 is a process flow diagram of an embodiment method.

DETAILED DESCRIPTION

The various embodiments will be described in detail with reference tothe accompanying drawings. Wherever possible, the same reference numberswill be used throughout the drawings to refer to the same or like parts.

The term “hospital” is used herein to mean “any healthcare deliverylocation”. Any embodiment described herein as in a “hospital” orrelating to a “hospital” includes physician offices, emergency andurgent care centers, rehabilitation centers, ambulances, and such otherpatient care points where patient data can either be acquired, handled,stored, and/or interpreted. It has also to be noted that this structurecould be used in other data processing scenarios, such as in remotereview of medical images (telemedicine), clinical study protocols, etc.

The various embodiments address the needs described above. The variousembodiments may also be relevant to other secure communication systemswhere part of the data needs to be readable at an intermediateway-point, or in situations such as in blinded clinical studies wherepatient data or other elements of a data file are to be hidden whilerelevant data needs to be selectively accessible to different parts ofthe client base.

Systems and techniques for enabling communication of medical informationbetween the source of clinical data, such as ECG machines, imagingequipment, or databases of such information such as hospital electronicmedical record systems or subsystems thereof, and a physician's mobiledevice are disclosed in U.S. patent application Ser. No. 11/778,744,entitled “System For Remote Review Of Clinical Data” and Ser. No.11/778,731, entitled “Method For Remote Review Of Clinical Data”, filedcontemporary herewith, the entire contents of both of which arepreviously incorporated by reference. The various embodiments of thepresent invention provide methods for securing medical information sentover communication systems with public components, such that securitycan be assured even in instances where security of a data server may bebreached.

For diagnosing and treating patients, physicians rely on patients'personal and medical information. This sensitive information iscollected and stored as patients' medical records and may includeinformation such as patients' personal identity (e.g., name, address,date of birth, social security number, etc.), present and past medicalhistory, physical examinations, vital signs, laboratory data, imagingdata and any other measurements taken or treatments planned byhealthcare providers. Because physicians rely on this data to managepatients, ready access to such records is important to reducing the timeand cost of patient care and medical services.

Accessibility to medical records is particularly important wheneffective diagnosis and treatment depends on timely assessment ofmedical data. In many instances, quick diagnosis and proper treatment ofan illness, injury or condition can mean the difference between life anddeath. For example, a patient with chest pain may be suffering a heartattack, in which case timely diagnosis and treatment may prevent deathor long term disability of the patient.

Ready access to medical records is also important for reducing the costsof healthcare. For instance, when a medical consult is requested from athird party physician, the ability to remotely access medicalinformation may reduce the cost and improve the effectiveness of theconsult by allowing physicians to evaluate patients from a locationother than the bed-side, reducing the time and cost of travel to thepatient location unless it is necessary.

To render an opinion, make an order and/or prescribe a treatment plan aphysician must be able to readily access and evaluate a patient'smedical records. However, there are many situations in which today'shealthcare systems fail to provide physicians with ready access tomedical records. For instance, a physician's expert opinion may berequired to manage a hospital patient after normal business hours.However, physicians are currently unable to receive comprehensivemedical records from any location other than at a patient's bed-side orfrom the hospital record center. To obtain medical records and tocompensate for the insufficiencies in current medical informationsystems, physicians may exercise several methods. First, a physician maytravel to the medical facility to physically review the patient'smedical records. This can be time consuming and expensive, potentiallydelaying patient care and impacting the physicians' quality of life.Second, to procure a medical opinion, medical records may be read tophysicians over the telephone. This method is inefficient and may leadto misdiagnosis and mistreatment since such verbal communication may bemisunderstood and the import of medical information may not be fullyappreciated by the physician. In addition, some types of medicalinformation, such as Electrocardiograms (ECG, a.k.a. EKG) and medicalimages, cannot be readily described over a telephone and so may need tobe faxed to a physician. Facsimile transmissions run the risk ofcompromising patient confidentiality, and the quality of recordsreceived by facsimile may not be optimal. Finally, a hospital may postpatient medical records on a website portal which may be accessed byregistered physicians. Once a physician is paged or called forconsultation, the physician may access the medical records over theWorld Wide Web (WWW) using a computer. However, a physician's access tovirtual medical information is tied to access to the Internet and acomputer which not only hinder his mobility but also may reduce hisavailability.

The above-mentioned methods for accessing medical records are alsoineffective during medical emergencies or when medical data must bereviewed immediately. For example, an obstetrician consulting aneonatologist must physically be present on location to reviewtime-critical data in order to render an opinion. Similarly, acardiology consult must be physically present during the performance ofan echocardiogram (Echo) to rule out or diagnose heart disease in apatient with acute chest pain.

The currently available methods for accessing patient medical recordsalso fail to deliver time-critical medical data from ambulances or fieldmedical devices to treating the physicians before the field emergencycrew arrives to the medical facility. Field emergency personnel facedifficult situations when, for example, their time of arrival to amedical facility is delayed due to traffic and critical medicaldecisions are pending. In many instances, correct and timely medicaldiagnosis and guidance by physicians located remotely at a medicalfacility could reduce the morbidity and mortality rate of patients beingtransported. Such timely medical diagnosis and guidance can only beachieved when the physician located at the medical facility can accessmedical data collected by the field medical personnel.

Medical record accessibility is complicated by the strict requirementsand guidelines set by the Federal and State Governments in regulationssuch as the Health Insurance Portability and Accountability Act (HIPAA).HIPAA requires that healthcare facilities implement restrictive securitysystems to protect patients' medical information. Thus, while there is aneed for mobile access to medical records, such access must also preventmedical records from being compromised, either by accident or bymalicious efforts.

The cost of caring for patients at a medical facility and billing forsuch costs generally must be tied to physicians' actions, diagnoses andtreatment recommendations. A complete patient care record, including aphysician's treatment plan, also may be important in legal proceedingsresulting from patients suing physicians. Therefore, it is importantthat medical facilities collect and maintain accurate records ofphysician actions, diagnoses and treatment plans for every patient.Currently, remote diagnosis and treatment of patients do not allowphysicians to personally and directly enter their findings and treatmentplans into patient charts.

There is, therefore, a need for systems which can make medical dataaccessible to physicians at any location, at any time, and withoutsignificant delay while complying with all the privacy laws andregulations. Such systems must be capable of reviewing these multipletypes of medical data, and also allow physicians to communicate theirfindings, orders and treatment plans to the appropriate persons.Furthermore, such systems must be able to maintain an accurate record ofphysician's attendance to patients. The various embodiments of thepresent invention provide systems, methods and apparatus to meet theseneeds.

The various embodiments provide systems, methods and apparatus formanaging and transmitting various types of patient information to aphysician's mobile device, such as a cellular telephone, and fortransmitting the physician's orders back to an attending facility. Thevarious embodiments allow patient data from a collection device (e.g.,medical diagnostic equipment) or a database containing patient data tocommunicate with a physician's mobile device thorough a server. Suchservers can be configured so that the importance of a medical emergencyor situation may be accurately transmitted to the physicians. Theservers may also have a graded response capability wherein the servermay contact the physicians in one or more different ways to ensuredelivery of the data.

Examples of the types of data managed and communicated to a physician'smobile device include: patient demographic data, such as name, age, sex,current medications, prior diagnosis, etc.; time-variant one-dimensionaldata, such as electrocardiograms and electroencephalograms; still ormoving images, such as ultrasound, X-ray, and catheterization labimages; laboratory results, such as cholesterol levels, urine testresults, blood dissolved oxygen levels, etc.; and/or measurements ofcritical patient parameters, such as blood pressure, pulse rate, andbody temperature. The data may be processed prior to transmission inorder to minimize file sizes to allow it to travel over various networkssuch as wireless networks. The format of the data may also be optimizedfor viewing on the display of the physician's handheld device usingprocessing software operating on a hospital console, network server orthe handheld device itself. Such image optimization may enable aphysician to view an accurate account of the transmitted images andperform measurements on any mobile device, even on mobile devices withsuboptimal display resolution.

After reviewing the transmitted data on the handheld device, physiciansmay communicate their findings and prescriptions to the treatingfacility. All communications may be automatically recorded in patients'files for billing and record keeping. The transmitted physician ordersmay travel from the handheld device through a server to reach a consolein the treating facility. The receiving console may then appropriatelydisplay or route all or portions of the physician's orders, either withsome manual intervention or automatically, to sub-systems connected tothe console or on the facility's network.

The various embodiments allow medical data to be accessed directly by aphysician using a mobile device. This access may include datainteractions, such as on-demand data transfers between electronicmedical record databases and the physician's mobile device. Theperformance of such interactions may be optimized using multi-formatnetworking, such as switching between wireless Ethernet and cell phonenetworks.

Further embodiments provide workflow enhancements such as automatic orsemi-automatic integration with billing system and patient dischargewhere multiple messages must be sent to multiple personnel in multiplelocations.

An exemplary embodiment of a general system for communicating patients'medical data to a physician's handheld device is illustrated in FIG. 1.As shown in FIG. 1, medical data may be collected in the field, such asan ambulance 101 or air-ambulance 102, or from diagnostic equipment,such as an ECG 103, within a medical facility. The collected medicaldata can be sent directly from a measuring device to a network, such asan Ethernet/Internet 121. Alternatively, medical data may be sent from adata collection device 101, 102, 103 to a user console 120 which isconnected to the Ethernet/Internet 121. Medical data can be sent fromthe console 120 via the Ethernet/Internet 121 to a server 130 which isconfigured with software to transmit the data (either with our withoutprocessing) to a physician's mobile handheld device 150 using a wirelessnetwork 140. As illustrated in FIG. 1, physician's diagnosis and ordersmay be transmitted back to the user console 120 at a medical facilityusing wireless and wired data communication networks 121, 140. Once thephysician's orders are received at the user console 120 in the medicalfacility, medical staff may treat the patient accordingly. It will beappreciated that the various functions implemented in this system may beaccomplished in software and/or hardware implemented on the console 120,the server 130 and/or within the medical device or database serverconnected to the network.

Patient medical data may be collected in any number of conventionalways. For example, patient data may be collected in the field by amobile medical facility such as a road ambulance 101 or an air-ambulance102. Alternatively, a patient may be admitted to a non-mobile medicalfacility such as a hospital or an emergency clinic and medical data maybe collected by, for example, a standalone ECG system 103 at thatfacility. Medical data may be collected by other medical devices, suchas, patient monitors including various subsystems for each vital signsuch as SpO2, temperature, Blood Pressure, heart rate, etc., variousimaging equipment, pacemaker monitors and interrogation devices,laboratory equipment, and other medical data collection systems. Datamay also be collected by a patient's home monitoring systems 104, whichmay report physical, chemical, electrical or other patient's medicalparameters, as well as medical device status information necessary todetermine the proper operation of a medical device.

Medical data from these various sources may be received and collectedwithin a data interchange server 110. When the medical data iscollected, it may be transmitted immediately to a physician's mobiledevice 150 or it may be stored for later use. If it is to be used at alater time, the collected patient data may be stored on hospitaldatabases and/or servers. These databases or servers may include generalhospital data interchange servers 110, department specific data serverssuch as an ECG server 111 or DICOM server 112, or a data consolidationserver such as an electronic medical record (EMR) server 113.

Operation of the various embodiments may be best understood byconsidering an example of the system in action. In this example, a user,such as an emergency room (ER) nurse, on a hospital console 120 requestsa physician's consultation on an urgent patient situation while thephysician is not in the hospital. To make the consultation request, theuser uses tools (e.g., a graphical user interface) on a user console 120to select medical data that is to be transmitted to the physician. Theuser console 120 may be coupled to the data sources, such as an EMRserver storing patient medical records, a DICOM image server or amedical device, such as an ECG server 111 by the hospital's network. Theconsole may also be coupled to wireless and external networks so that itcan receive medical data directly from remote sources, such as anambulance 101, air-ambulance 102 or the patient's home systems 104. Theuser console 120 is also connected to an external network, such as anEthernet/Internet 130 for communication with external data communicationnetworks. The user may enter contextual information into the userconsole 120 to inform the physician of the nature of the request oremergency, the location of the patient, and the desired consultation orrequired action. In other instances, the identification of the consoleor data source, might itself automatically provide location information.If required, the user may use tools on the console 120 to retrievestored medical records from historical and patient record databases fromone or more of the available sources. Finally, the user may format orassemble the consultation request and associated medical data andtransmit the assemblage as a message to be delivered to physician'shandheld device 150. By way of the Ethernet/Internet 130 connection themessage and data are sent to a message delivery server 130 where it isprepared for transmission to the physician's handheld device 150 via anavailable wireless network 140 linked to the mobile device. In aparticular embodiment, the server 130 first sends an SMS message, via acellular network SMS server 132, to the physician's handheld device 150notifying the device that a data package is available for downloading.In response to the SMS message the handheld device 150 can send adownload request back to the server 130 which then transmits the datavia a server 131 (which may be optimized for communication to mobiledevices, and hence sometimes referred to herein as a mobile web server),an e-mail server 133 or other wireless transmission facility. Thephysician then reviews the data presented on the handheld device, entersan order, observation, request or treatment plan, and transmits suchinformation back to the user console 120 via the wireless network 140and server 130.

It will be appreciated that the user console 120 may be a standalonecomputer or work station, or the processor within any of the exampledata source servers 110, 111, 112, 113, or a medical device 103, withthe console functionality provided by an additional software programloaded on the processor. Also, in an embodiment, the console 120 may belocated within the ambulance or air-ambulance to enable EMT personnel totransmit patient data directly to a physician without the need toinvolve an intermediary operator on a hospital console.

For example, the console 120 may be used as a separate system toretrieve data from the databases or data collecting devices to which itis connected, with such retrieval operations initiated automatically,semi-automatically or manually by operator commands. Various datacollecting devices and databases may be connected to the console 120either by wire or wireless networks. When the system is configured toautomatically transmit data to the physician, data from medical devicesmay be transmitted to the console 120 and then automatically channeledto the communication server 130 where it is sent on to the physician'smobile device 150. This configuration may not require a console operatoror a separate console processor as the console functionality may beincorporated into the medical device 103 processor or the server 130.

Manual entry of information onto a console 120 may include inputtinginformation from the operators' own findings, retrieving informationcollected by medical devices, and/or retrieving patient medical records.It may also include entering data from multiple sources acquired eitherelectronically by means of a communication link, or manually by means ofa removable storage media such as floppy disks, or USB drives. In otherinstances, the console 120 operator may enter data manually by means ofa keyboard and by copying and pasting from different applicationsresident on the same computer as the console 120 software program.

An example of data that may need to be entered manually into the console120 is the patient's vital signs. In applications where only vital signsare of relevance, the data may be imported by electronic means, becopied and pasted from another connected resident software program onthe same computer system, or manually entered into a tabulated form onthe screen of the console 120 along with any comments. An example ofsuch a situation is a console located within an emergency room intowhich an ER nurse may enter patient identity information and vital signsstatistics, and/or connect patient monitoring equipment, such as an ECGmachine, to receive and record medical data.

Once the medical information is collected and communicated with orentered into the console 120, the data may be encrypted or scrambled andtransmitted through an Ethernet/Internet network 121 to a server 130.Such a network 121 may include the hospital's internal communicationnetwork, which may be wired, wireless or a combination of wired andwireless networks. The network 121 may include various firewalls andother security and network integrity features known in the art.

The server 130 may be located anywhere within a medical facility or beremotely located outside of such facility. Also, the server 103 may belocated internal to the console 120, physically integrated into theconsole 120 or exist as a software program that resides within theconsole software. Alternatively, the server 130 or a portion of thefunctionality described herein as occurring on the server 130 may beintegrated into or exist as a software program that resides within aprocessor coupled or integral to a medical imaging system, such as a CTscanner, X-ray system, ultrasound imaging system, EKG system, etc. Theserver 130 may be a single device dedicated to facilitatingcommunication with physician handheld devices, or it may be amultipurpose network server that is additionally configured withsoftware to perform the functions associated with physician handhelddevices, or a collection of various servers/computers that offerdifferent aspects of functionality needed to perform the necessaryoperations expected of such a server.

In general, the server 130 is configured to enable one or more medicalfacilities or their departments to upload data onto a common server 130for transmission to physician handheld devices. The server 130 mayinclude multiple functional units, with one or more of these units beingpart of a single computing system (i.e., as software function units) orlocated separately on separate processors. Examples of separateprocessors or functionality units include a mobile web server 131, anSMS message server 132, and an e-mail server 133. For example, a dataserver 131 is a functional unit which stores and distributes medicaldata in a secure fashion to systems with protected user access and maycontain logic for distributing received data and messages. Such logicand authentication technologies may also be located in the console 120,with the server acting as a pure data source through which encrypteddata is passed.

Another example of a functional unit is an SMS server or other messagingmanagement server capable of sending messages to a device through atelephone network for mobile phones and devices. The SMS server 132 maybe located within or separate from the server 130 and is capable ofsending messages to mobile devices through a public cellular telephonenetwork or a combination of different public telephone networks. The SMSserver 132 may also be enabled to accept and recognize the urgency andcriticality of correspondence messages which were communicated by theconsole 120 or receive from a handheld device 150. The SMS server 132,or the server 130 directing the SMS server 132, may include software tosend timed and/or multiple messages to a physician's mobile device 150until the relevant message data is successfully downloaded by thephysician's device, or a response from the physician is logged by thedata server 131 or the console 120. Alternatively, such functionalitymay reside in the console 120.

When messages are received by physicians, they are able to declarewhether they are available to review the patient's data. Thisdeclaration may be entered into the handheld device as a message or as aresponse to a menu option. If the response is in the negative, theserver 130 may be configured to inform the user at the console 120 as tothe physicians' lack of availability. The consult request can then bere-routed to other available physicians by the user via the console 120.

Alternatively, a software application may be made available on thehandheld device through which a physician may indicate his/heravailability, which may then be communicated to the server 130. Thisinformation that the physician is not actively receiving messages mayfurther be communicated to the console which may then indicate to theconsole user either while or before formulating a message to saidphysician, This information may further be used on the server tore-route messages to a different physician, if so set up, such that theconsole user is able to automatically get in touch with an expertphysician in cases where the originally intended physician is notavailable.

In yet another embodiment, the primary functioning of which is detailedlater with reference to FIG. 7, the server and the handheld may havecommunication methodologies included by which the server is updated fromtime-to-time regarding the availability of each physician's handhelddevice. Such availability information may be a combination of thehandheld device storing and reporting each physician's personal options,such as a “do not disturb” option, and the handheld device'savailability on the cellular network. Such physician availabilityself-reported information provided by this embodiment may also be usedto support the functionality described in the previous paragraph.

Yet another unit of the server 130 may be an e-mail server 133. Ane-mail server 133 may be configured send e-mail messages to thephysician's mobile device 150, directly or indirectly, as well asreceive messages in e-mail format sent by the console 120, the SMSserver 132 other locations, such as a referring physician's office. Thephysician's mobile device 150 may download the e-mail message with themedical data attached using convention wireless e-mail messagecommunication protocols. Such e-mail messages may be downloaded eitherautomatically, in predefined time intervals (e.g., every 10 minutes), ormanually when the physician is notified of the availability of an e-mailmessage by an asynchronous mode of messaging, such as an SMS messagesent via the SMS server 132. Other modes of e-mail delivery currentlyknown in the art may also be used.

Because the information communicated through this system may includecritical patient medical information, it is important that the server130, especially those servers that are remotely located, perform withhigh reliability and without delay. For example, the server 130 may beconfigured to detect problems with the delivery of a message to aphysician's handheld device 150. This may be achieved, for example, byconfiguring one or more different or integrated pieces of softwareoperating on the server 130 to periodically transmit test messages. Suchtest messages may mimic one or more aspects of the real messages routedthrough the server 130 or functional units of the server. Alternatively,the server 130 may simply send a periodic message requesting anacknowledgement response. The server 130 may further be configured withsoftware to recognize when a message sent to a physician has not beenreceived or when connectivity to the physician's handheld device is nolonger available, and to notify the appropriate persons, such as anoperator on the console 120, by one or more means of communicationincluding e-mail, SMS messaging, paging etc. Such functionality helpsassure speedy detection of communication flaws within the messagingserver and thereby allow steps to be taken to increase reliability.

In addition to testing the communication links between the server 130and the physician's handheld device, the server software may alsoinitiate test or simulated message transmissions from different pointswithin the server's 130 main software to check for proper reception atsome other points downstream to the point of injection in the data flowpath. Such testing can verify the integrity and reliability of theentire communication system, including network connections within thehospital infrastructure.

The foregoing description of communication link testing may also beperformed over all types of communication links available to the system.For example, wireless communication links used to transmit data to andfrom physician handheld devices may also include 3G and satellitetelephone data links. Thus, in addition to testing the conventionalcellular telephone data network, the server 130 may periodically testbackup communication links in a similar manner. If a backup link isdetermined to be unavailable or unreliable, that information may becommunicated to the operator on the console 120, such as in the form ofan informational message, a warning symbol or icon, or other displayfeature.

Because patient medical information is confidential whose protectionsand disclosure are governed by Federal and State laws and regulations,such as HIPAA, it is important that the communicated medical data isprotected during its transmission. An embodiment of the presentinvention provides systems and methods for ensuring that all medicaldata is protected while they are transmitted and that only authorizedpersons have access to such data. The transmitted data may be encryptedor scrambled, and various user access validation steps may beincorporated to protect the integrity of the data and the privacy of thepatient. For example, encrypted medical data may be transmitted from theserver 130 to a physician's mobile device 150 only when the identitiesof the physician and the physician's mobile device are authenticated.The identity of a physician may be authenticated by requiring atime-sensitive log-in process with a strong password known only to thephysician. Authentication of a mobile device may be achieved byidentifying unique identifiers on the cell phone, such as the telephonenumber, the serial number of the device, the transponder ID number, orany such identification data, all of which can be loaded on the server130 during the mobile device registration process.

Also, data may be encrypted before it is transmitted from the console120 to server 130. Once at the server 130, part or all of the data canbe decrypted. The data may again be encrypted before transmission to themobile device 150 and only decrypted after the device and the personaccessing the data have been authenticated. To prevent unauthorizedpersons from accessing sensitive patient data, the server 130 may alsoneed to be protected with strong temporary passwords. Other methods forprotecting data that are well known in the art, such as the use ofdigital certificates, may be used in addition to or in place of theabove described methods.

In some installations, the server 130 may be a storage facility forstoring electronic medical data from one or more data sources. In suchinstallations, stored data may be accessed by using any securepublic-domain network application, such as the Internet, provided thatthe software resident on the reviewing computer is capable of beingauthenticated and have software capabilities to decrypt or unscramblethe stored data files.

In various embodiments, medical data stored in electronic format may beanalyzed by the console 120 or server 130 in order to recognizediagnostically significant patterns that may be identified to aphysician. For example, ECG data may be analyzed using patternrecognition software to identify abnormal patterns, such as arrhythmia,tachycardia, or fibrillation. When recognized, the console 120 or server130 may be configured with software to automatically orsemi-automatically transmit the conclusions, perhaps in combination witha selection of the ECG data, to the physician's handheld device. Asanother example, the console 120 or server 130 may be configured withsoftware to evaluate several types of diagnostic data simultaneously inorder to recognize potential diagnosis or identify potential risks. Forexample, the console 120 or server 130 may be programmed withknowledge-based diagnostic decision aid algorithms, such as thosedisclosed in U.S. Pat. No. 6,804,656, the entire contents of which arehereby incorporated by reference.

By performing data recognition and decision assistance algorithms in theconsole 120 or server 130, sophisticated diagnostic tools can beprovided to the physician outside the hospital without overburdening theprocessor within the physician's handheld device. Typical cell phoneshave limited available memory and processing power, and therefore wouldbe unable to provide timely analysis of complex diagnostic data. Byplacing the auto-recognition and expert system software on the console120 or server 130 and promptly delivering the results to the handhelddevice, the physician receives the benefit of such analysis tools as ifthe analyses were being done on his handheld device.

The server 130 may also include other artificial intelligence-basedfunctions, such as pro-actively locating and obtaining relevant patientinformation from the hospital's electronic medical record system andeither having it ready for dissemination into the physician's handhelddevice, or delivering such data in the background to the handheld devicefor quick review. Examples of such artificial intelligence-basedfunctions include preselecting or preloading previous or baseline EKG's,blood cholesterol measurements, last known weight, etc. for a patientwhose EKG is being sent to the physician for a complaint of Chest Pain.

In an embodiment, an audit function may be provided by includingsoftware on the server 130 or console 120 to monitor and record allaccesses to patient medical records and to create and maintain a recordof all such accesses. In this capability, every time patient records aretransmitted and/or reviewed via the system, that transaction may berecorded and maintained in a database for future reference. For example,when medical data is transmitted to a physician's handheld device, thattransmission of data will be recorded and maintained in an audit file,in the patient's medial files, in a communications log file, or someother suitable database. Similarly, when a physician receives medicaldata or requests access to such data by authenticating his password withthe system, his access may also be recorded and maintained in an auditfile, in the patient's medical records, in a communications log file, orsome other suitable database. This record may include the date and timeof access, the type of records accessed, the identity of the personaccessing the files and other parameters that may aid a security audit.

The auditing system may also include hierarchical access controlswhereby accessibility to medical data is directly related to the levelof clearance of the viewer. For example, while a physician may have theability to view all the medical records of a patient, including labs,images and patient medical history, he/she may not have access tonon-medical patient information, such as billing information or personalidentifiers such as the social security number. On the other hand, abilling specialist may have access to patient billing information butnot to any of the patient's medical records.

In an embodiment, user authentication capabilities may be included onthe physician's handheld device. More than one person may have access toa mobile device and handheld devices are subject to being misplaced orstolen. To accommodate this, the system may be configured to identifyand authenticate the person requesting access to medical records from ahandheld device before the records are transmitted. Followingauthentication, the system may then transmit only those portions of thepatient's medical records and other personal information that theauthenticated user is authorized to view. For example, if a physician'snurse also has access to the system through the physician's mobiledevice, the nurse with be authenticated by his/her personalauthentication information (e.g., user name and password, finger printscan, etc.) and will be allowed to receive and view only the specificportions of medical records for which the nurse is cleared.

FIG. 2 illustrates an exemplary embodiment of a portion of the systemillustrated in FIG. 1 in which results of electrocardiograms (ECG) aretransmitted to a physician's mobile device 150 to enable the physicianto evaluate a chest pain patient without having to be in the hospital.This capability enables the physician to review the patient's relevantmedical information, including viewing some or all of the ECG trace, onthe mobile device 150 wherever the physician happens to be at the time.This allows the physician to make a quick evaluation and issueappropriate orders without the delay of traveling to the hospital andwithout completely interrupting the physician's activities. Thephysician can enter orders into the mobile device 150 which can thentransmit those orders back to the server 130, which sends them on to theconsole 120, thereby providing the attending nurse or physician with adiagnosis and treatment plan. When evaluation of a chest pain patient isrequested by the operator on the console 120 (e.g., ER nurse orphysician), the relevant medical records transmitted to the physician'smobile device 120 may include the patient's illness history, pastmedical history, results of physical exam, vital signs, Echo results,ECG results, and/or any past ECG results for comparison.

Referring to FIG. 2, a chest pain patient's medical evaluation mayinclude conducting an electrocardiogram using an ECG unit 210 andstoring the ECG recordings within the patient's electronic medicalrecords and/or in an ECG data server 111. When an evaluating physician,such as a cardiologist, is not physically present at the patient'sbedside, ECG information collected from the patient may be communicatedto the physician's mobile device 120. To communicate this information tothe physician, the ECG information may first be transmitted to a userconsole 120. Additionally, medical records may be downloaded from an EMRdatabase server 113 to the console. If vital signs are stored orrecorded on another system, such as vital signs server 212, thatinformation may also be downloaded to the console 212. From the console120 the ECG recordings and other relevant patient medicalrecords/information may be transmitted to the data server 131 which willin turn communicate that data to the physician's mobile device 150. Oncethe physician reviews the data, he may input his diagnosis and treatmentplan into his mobile device 150 which will transmit this data back tothose who requested the consultation via the data server 131 and theconsole 120.

The process for effecting this communication begins with the collectionof new data from the patient or by using previously collected data, step230. New ECG recordings may be obtained by attaching leads of an ECGmachine 210 to the patient's body. The recoded ECG may be transmittedautomatically to the console 120 as the ECG machine 210 records theactivity of the patient's heart. The ECG recording may also be archivedin an ECG database 111 and then transmitted to the console 120 from thatdata server 111. Other previously recorded ECG for the same patient mayalso be available in the data server 111. When, for instance, acomparison of a patient's current ECG with old ECG results is required,both ECG records may be obtained and transmitted to console 120.

Similarly, vital signs which are a collection of a patient's biologicalmeasurements such as, SpO2, temperature, heart rate and blood pressure,may be retrieved for transmission, step 231. Vital signs measurementsmay be obtained from separate units, from a central database, such as avital signs server 212, a patient monitor, or a central monitoringstation. Vital signs may also be continuous recordings of breathing, orcontinuous time-variations of SpO2 or such other parameters. Other data,such as patient's demographics, or patient's present illness history orpast medical history and results of physical exams may also be obtainedfrom an electronic medical records system 113. Once this various medicaldata is obtained, it may be transmitted to console 120 for furtherprocessing. All transmissions of data between the data collectiondevices, medical databases, the console 120, the data server 131 and themobile device 150 are encrypted and secured.

In an exemplary embodiment, instead of being a separate unit, theconsole 120 may be a software program embedded within a device whichcollects or stores medical data, such as the ECG machine 210, ECG database server 111, vital sign server 212, or the electronic medicalrecords system server 113. Medical data, such as ECG records may becommunicated to the console 120 by a custom interface developed with oneor more ECG units through wired or wireless networks. Additionally,medical data, such as ECG recordings, may exist in any number of knownformats, including DICOM, OpenECG, Philips XML, or FDA XML formats. Thesoftware operating in the console 120 or the server 131 may beconfigured to interpret received medical data in different formats andconvert them to a common format before communicating such data to therest of the system.

Once the ECG recordings and other relevant medical information has beendownloaded to the console 120, it may be communicated with the dataserver 131 for transmission on to the consulting physician's mobiledevice 150. The process of transmitting medical data from the console120 to the data server 131 may be either automatic or manual. In anautomatic process, for example, the ECG unit 210 may be configured totransmit the collected ECG recordings to the console 120 which may beconfigured to transmit the data to the data server 131 automatically.The data server 131 then can transmit the data the mobile device 150with a review request, with or without any auto-interpretation from thesoftware resident on any one or more of the ECG unit, the console,and/or the server.

In a manual process, an operator may orchestrate the transmittal of datafrom the console 120 to the data server 131. To manually create andtransmit a message to the data server 131, the console user, such as anurse, may first need to log into the console 120 and authenticatehis/her identity. Such authentication may be compliant with currentFederal and State laws and regulations governing patient privacyprotection, such as HIPAA regulations. Once the user is authenticated,the console 120 may guide the user to select a patient name, step 231,to establish access to those records. The selected patient's medicaldata is then sent to console 120 for the user's review, step 231. Oncethe medical data is available to the console 120, the user may select toadd data such as, ECG records, step 230, of a patient to the messagedestined for the consulting physician. It will be appreciated thatdownloading ECG data, patient medical records and vital sign data may beperformed in any order or sequence.

The user may edit the length of the ECG records or highlight portions ofparticular significance, step 232. Editing an ECG record allows the userto select relevant portions to be transmitted to the physician. This maybe important because, for example, Holter monitor signals from the ECGdatabase 111 could be several hours long. Therefore, editing out theirrelevant portions of an ECG medical record to allow transmittal of ashort section of the record may be beneficial.

The user may also include and edit other relevant data, step 233. Suchother data may include, for example, notes, new or old vital signmeasurements, other medical data, such as ultrasound and/or X-rayimages, and specific consultation requests. Adding additional materialmay be achieved through a direct interface between the console 120 andother medical records databases such as the vital signs measuringsystems or databases 212. Additional data may also be added to anyoutgoing messages by manual entry of data via a keyboard into afree-text entering field, or through a structured data entry method,such as a form or spreadsheet presented on the console display. Suchdata may also be entered by copying and pasting from other databases,such as EMR systems.

Once a message is constructed, the user may classify the message asbeing, for example, urgent or non-urgent, or specify a required responsetime for obtaining a response from the consulting physician. Suchfunctionalities may be important in cases where timely response iscritical, such as when a patient's life may depend on an immediateconsultation. The physician's availability and his/her field ofspecialty may be available through the databases which are accessible bythe console 120 or reside on the remote server 131. Once all messagecontents are selected and the message has been assembled, the user mayselect to send the message, step 234. The message may then be given aunique ID by the console 120, step 236, encrypted using, for example,128 bit encryption, and transmitted to the data server 131, step 237.The ID generation for the message may also be a function of the dataserver 131.

Once the data is transmitted from console 120 and uploaded by the dataserver 131, the data server 131 may authenticate the data and run errorchecks to confirm the data was successfully received. The server mayfirst determine the importance of the message by reading the importanceor time limit information entered by the user, step 237. Depending onthe classification of the message received from the console 120, thedata server 131 may do one of several things. The data server 131 maydirectly or through a different server send an SMS message or an e-mailmessage or both to the physician's mobile device 150 using a cellularphone network 250, step 239. If the data server 131 determines that themessage is classified as important or urgent, step 237, it mayautomatically generate an SMS message including a pointer to a wirelessaccess protocol (WAP) server (also referred to herein as a mobile webserver), step 239, to also be sent to the physician's mobile device.Alternatively, if the data server 131 determines that the message is notclassified as urgent, step 237, it may send an e-mail to the physician'smobile device 150, step 238. E-mail addresses of physicians may beavailable on the data server 131 or in the console 120, or may bemanually included in the message by the user via data entry into theconsole 120. The data server 131 may be configured so that the e-mailtransmitted to a mobile device 150 may carry the attached medical dataor transmit the e-mail text without an attachment but with a hyperlinkto a website from which the attachments may be retrieved.

The data server 131 may also be configured by software, on acase-by-case basis using known programming techniques, to allow selectedsections of a transmitted message to reach the mobile device 150 withinan SMS message. Such an SMS message may identify the sending console 120and/or the requesting institution, the patient identifier, the type ofdata to be downloaded, and the urgency of the message. Otherinformation, including the message composed by the sender, may also formparts of the transmitted SMS message. SMS messages may be a summarizedversion of the original message or may share unique identifiers with thecomplete uploaded data. Hyperlinks or data pointers in the SMS messagecan be included to allow the physician's handheld device 150 to accessthe complete uploaded data from the data server 131 by parsing the SMSmessage.

SMS messaging may also be used for background notifications to thephysician or to the handheld device 150. Such SMS messaging may be amodification of currently known forms of SMS messages. SMS backgroundmessaging services can be modified to encompass more data (e.g., byusing MMS formats). Alternatively, similar to current SMS systems, onlythe SMS message, explicitly or implicitly including the appropriate datalinks, may be displayed on a commercial cell phone. Use of conventionalSMS messaging may require a sign-in and user authentication requirementencompassing all SMS functions on the handheld device in order to complywith HIPAA requirements.

All advantages of sub-functionalities of SMS and MMS messaging systemsmay also be included as system features. These may include confirmationof SMS/MMS delivery to the handheld device 150. Using the messageacknowledgment feature of SMS/MMS messaging may allow the console 120 ordata server 131 to calculate the physician's response time, or to send areminder, step 240, if no response has been received from the physicianwithin a set time period following delivery of the message.Alternatively, if a SMS is not confirmed as delivered within a certainperiod of time, another physician may be selected, either manually orautomatically, for consultation, or another mode of communication, suchas e-mail or telephone may be used to inform the physician.

In instances where the data server 131 receives data from a datatransmittal means, the data server 131 may be configured to authenticateeach point of data transmittal. Data transmittal means may include aconsole 120 or a mobile device 150. For example, the data server 131 mayuse a unique serial number assigned to each data transmittal means inorder to authenticate it. Additionally, the data server 131 may beconfigured to authenticate any person using the transmittal means toprovide sufficient data security and ensure patient privacy. This may beachieved by use of unique passwords or identifiers assigned toauthorized users.

A mobile device 150 which receives an SMS message, step 260, willtypically be configured with software applications capable of receivingand identifying SMS messages from data servers 131. Upon receipt of anSMS from a data server 131, the background application may launch a maindata review application on the mobile device 150. To view any messagessent from data server 131, the reviewing party may first need toauthenticate his/her identity, step 261. Once the user has beenauthenticated, the data review application may, automatically ormanually, download the data files, step 262, such as the ECG records,from the data server 131 through a wireless cellular network. In anembodiment, the handheld device 150 initiates downloading of data filesby activating a hyperlink or data file pointer included within the SMS(or e-mail) message that has been received, or simply by replying to theSMS (or e-mail) message and requesting data transmission.

The data review application may include features to facilitate thephysician's review of sent medical data on the handheld device 150. Forexample, if the data review application is configured such that thephysician has to permit the download of the data, then a remindingmechanism may be configured to alert the physician of pending messagesthat should be accessed or downloaded. The interval and frequency ofsuch alerts may depend on the classification of the transmittedmessages. Thus, if a message is marked urgent, then the intervalsbetween reminder alerts may be short.

Once the physician accesses the transmitted medical data, he may reviewthem and enter his comments or opinions, perform measurements, enterannotations at various sections of the data sent, devise a treatmentplan, enter prescriptions or perform any task necessary to hisconsultation, step 263. Appropriate data entry modules, such as forms,text boxes, measurement tools, and annotation tools will be available asfeatures of the data review application to enable the physician to carryout such essential activities.

In the course of his review, the physician may have clarifying or followup questions regarding the transmitted data or the case. In suchinstances, the data review application may be configured to allow thephysician to send a message through the data server 131 to the console120. The console 120 or the data server 131 may also be configured withsoftware to respond to such messages automatically or to present analert or otherwise notify a user that a physician question has beenreceived.

Upon completion of his/her review and entry of the relevant orders,notes, requests and data into the handheld device 150, the physician'sresponse with all the relevant data may be uploaded to the data server131 using wireless data links, step 264. The SMS transmission mayinclude security and authentication information, such as a digitalcertificate to validate and authenticate the message to the data server131. When the message is received, the data server 131 uploads the datafrom the mobile device, and performs authentication and messageverification, step 270, and then transmits the physician's response backto the console 120, step 275, where it can be retrieved by the operatorin treating a patient. Copies or portions of such data may also beconverted to one or more other formats, such as HL-7 or XML, and sent tovarious hospital databases, such as the electronic medical recordsystems 113 or billing systems.

A mobile device 150 may also be configured to receive e-mails withelectrocardiograms as attachments, step 265. In such an instance, thedata review application may be launched to facilitate the physician'sreview of the message and attached data, step 266. As with SMS messages,the physician may input his/her diagnosis, orders, prescriptions etc.into the handheld device 150, step 267. The data review application maythen formulate an e-mail and send it back to the data server 131, thereferring physician, the physician's office and/or the hospital, step268. This email sends relevant data back to the requesting facility orstaff. At the hospital this transmitted data may be received by theconsole 120 via the hospital's electronic mail system. The data withinsuch e-mail message may be compressed to allow minimum data densitywhile also allowing sufficient encryption and authentication.

Since the physician's handheld device will typically be a cell phone,the physician also has the option to place a call to the hospital, suchas to the user on the console who originated the message, step 269. Thefact that the physician placed such a call, and in some cases thecontent of the conversation, may be important for billing, patientrecord keeping, hospital administration, malpractice liability, or otherreasons. Accordingly, an embodiment provides capability to log when sucha call is placed, data concerning the initiation/duration of the calland, in some cases, a recording of the conversation. This call-relateddata may be stored in various databases within the system, such as inthe console 120, in the patient's medical records (e.g., by transmissionof the recorded data from the console 120 to the EMR server 113), in abilling server, and/or in some other database for storing telephoneconsultation records.

In order to diagnose and treat certain illnesses or injuries, physiciansmay need to review medical images, such as X-ray, fluoroscopy,ultrasound, Computed Tomography (CT scan or CAT scan), MagneticResonance Imaging (MRI), Positron Emission Tomography (PET scan), etc.Medical images may be simple two-dimensional still images, such as anX-ray or a slice image from a CAT scan. Medical images may also bemovies (or loops of movies) of two-dimensional scans, such as ultrasoundscans (with or without color information) and cath lab cine loops. It isnoted that some types of time-based (i.e., including moving images)medical images are created, stored and maintained as a series of stillimages even though they may normally be viewed by physicians as moviesequences. For example, cath lab films and cine loops are technicallynot movie files, but a series of still images that are maintained asseparate JPEG files within a single DICOM folder. For simplicity ofdescription and reference, medical image files maintained as a series ofstill images that may be viewed as a movie sequence are referred toherein and in the claims as a “movie” file. Thus, the term “movie” isintended to embrace any sequence of images that when viewed sequentiallyat an intended frame rate appear as a movie sequence.

Medical image may also be a collection of three-dimensional (3D) datasets, such as a 3D CAT scan, or time-dependent 3D data sets (sometimesreferred to herein as four-dimensional medical images), such as acardiac 3D scan using a CAT scanner or an echocardiogram. In order todisplay 3D images on two-dimensional display screens, such as aphysician's handheld device, the images may be displayed in isometricform as isometric images. Similarly, time-dependent 3D data sets may bedisplayed as rotating isometric movies. Additionally, in somecircumstances the physician may need to view photographs or video of thepatient, the patient's injury, or a site of an operation (e.g., an imagefrom an arthroscopic probe).

FIG. 3 illustrates an exemplary embodiment of a system and method thatenable communicating medical images to a physician's handheld device andproviding tools to enable the physician to remotely review such images.Medical images may be collected by an image server with known format112, such as DICOM, or an imaging device 301 also with known imagingformats. Alternatively, images generated by an imaging unit withoutknown formats 303 may be digitized from an analog image output 304 usinga frame grabber. Once the images are collected they can be transmittedor accessed by a console 120. These images may be stored in a databaselocated either inside the console 120 or outside of the console such asin a DICOM server 112. Additionally, these outside database locationsmay include servers on the hospital information system.

An operator or user, such as nurse, may use the console 120 to accessimaging data in order to create and transmit such data to a physician'smobile device 150 for consultation. To create such a message on theconsole 120, the nurse may select to access a patient's medical records,step 311. The nurse may then select one or more relevant medical images,or any sub area on an image (region of interest (ROI)) or sub-loop ofselected images, step 312. To complete the consultation request message,the operator may then include any other necessary medical data orcomments, including, for example, the patient's vital signs, medicalhistory, ECG, etc., and write a cover message to the physician, step313. The cover message may explain the patient's situation and thecontext of the attached medical files and images, as well as request aspecific consultation or evaluation. When the data are assembled andcover message completed, the entire message may be sent, step 314, tothe physician's mobile device 150.

From the console 120, the selected data with the selected attributes maybe uploaded to the data server 131 in a known format, which could beDICOM format. The data transmission may be encrypted and error checkedusing methods like those described previously regarding ECGcommunications. Additionally, the console 120 may edit or format theinformation, and attach header data as necessary to facilitate itstransmission to the physician's handheld device, 315. The console 120may also perform one or more compression or optimization steps, or useselected data directly or indirectly to access other data that might beuseful to have available on the server in case the physician requeststhis additional data implicitly or explicitly. Also, the console 120 mayassign a unique ID to the message and data set to enable tracking andrecording of the message and corresponding responses, 316.

The data server 131 receives the transmission from the console 120, 317.The data received at the data server 131 may include complete or partialimage files in a known format along with the spatial and temporaldescription of the regions of interest identified, as applicable. At thedata server 131, the image and message data are either transmitted tothe mobile device 150 or are stored to be accessed by the mobile device150. The data server 131 then prepares to transmit the message and imagedata to the physician's handheld device.

In a typical implementation, the data server 131 first sends an SMSmessage to the physician's handheld device, which is received anddisplayed, notifying the physician that a message is available fordownload, 331. The physician may initiate download of the message, suchas by pressing a key or selecting a menu option, or the handheld devicemay automatically initiate download, 332. To download an image file, amobile data exchange session is initiated with the data server 131 viacellular telephone data networks. As part of this step, the mobiledevice may also transmit to the server authentication informationconcerning the mobile device and the user to enable the data server 131to confirm the identity of the user and the user's clearance to reviewthe medical information in the message. The mobile device will alsoindicate the data to be downloaded, such as by initiating thecommunication via a hyperlink or attaching a point value included withinthe received SMS notification message.

Alternatively, the data server 131 may transmit the message and imagedata directly to the physician's handheld device without sending an SMSnotification message or waiting for the request an authenticationmessage.

Before sending image data, the data processor 131 may perform imageprocessing in order to present the image in a format suitable forviewing on the physician's handheld device 150. The ability of aphysician to view and analyze medical images will depend on the device'sdisplay characteristics (e.g., size, shape, resolution, refresh rate andrange of colors displayed). Therefore, depending on the mobile device150, the data server 130 may format the images before transmission tomake them more easily accessed and displayed. To prepare the images foreach mobile device, either the console 120 or the data server 131 mayfirst detect the display and the specification of the targeted mobiledevice 150. This may be achieved in a number of ways. First, the console120 or data server 131 may be configured to dynamically query the mobiledevice 150 to request it to transmit its display characteristicparameters before transmitting the images. Second, the console 120 ordata server 131 may be configured (e.g., during system installation orupon registration of a physician with the system) with a database ofmobile devices 150 correlated to each physician, with the databaseincluding the display characteristics of each device. By accessing thisdatabase, the console 120 or the data server 131 may determine thedisplay parameters for the destination mobile device and prepare theimage data accordingly. Third, the physician's mobile device may includeits display characteristic data in the download request message (step332). Other parameters that may be obtained in this step include theprocessor speed, the display processor speed (if separate such as in adual-processor device), the display quality on the mobile handhelddevice (color depth etc.), the memory availability, the cellular networkbeing used to access the data, the quality of the cellular connection inthe general area where data is being accessed, etc.

Once the display characteristics of the destination mobile device 150are known to the data server 131, image processing software operating onthe server may format the images for that device. While an embodimentfeatures the image processing software running on the processor withinthe mobile device 150, the preferred embodiment performs the imageprocessing on an external processor, such as the console 120 or dataserver 131. Running the image processor software on an externalprocessor shifts the processing load from the mobile device 150, whichnecessarily has limited processing and memory capability, to a processorwhich can be provided with sufficient processor and memory capabilitiesto complete image processing tasks very rapidly. Performing imageprocessing on an external processor, such as the console 310 or the dataserver 320, can enable speedy transmission of data to the mobile device150 by reducing the size of the file that must be transmitted.Performing image processing on an external processor enables morecomplicated image processing operations to be performed, such as imagesmoothing, edge detection and enhancement, and noise reduction, whichwould not be possible using the limited processing capabilities residenton the handheld device 150. This embodiment also allows use ofconventional mobile devices 150, which may have slower processors, orinferior display driver capabilities, without having to upgrade orconvert their image processors to provide sufficient processing speedand memory to receive, process and display large or complex medicalimages. Using a high speed external processor to quickly perform imageprocessing and reduce the size of transmitted image files (therebyshortening the image transmission time) can make the display of imagesappear to the physician as if the images are being locally processed.Further, the responsiveness of the system from the physician'sperspective can be improved by upgrading the external processor and itssoftware without the need to replace all physician handheld devices withmore expensive equipment.

To format an image, the image processing software may use the displayparameters of a mobile device 150 to optimize the resolution and aspectratio of transmitted images to match the display on the mobile device.Display parameters that may be considered in optimizing the transmittedimage include, the screen resolution in terms of pixels and colorsavailable (such as defined by the number of bits used in the colorscale), or the number of pixels available for displaying the image (suchas defined by the current screen resolution and the portion of screenmade available for image display). For optimization purposes, theprocessing software may also calculate aspect ratio of the screen, suchas calculating one or more frames of an image that corresponds to eithera positive or negative zoom step (if discrete on the handheld) ordetermining the next possible resolution in the positive as well asnegative directions wherein the region of interest of the image fits thescreen aspect ratio. In the case of movie loops, the region of interestand the zoom and pixel sub sampling can be applied to each frame of themovie loop such that one or more loops with the appropriate zoom levelare created at the server. More detailed descriptions of these imageprocessing and transmission operations are provided below with referenceto FIGS. 10-13.

The image processing software may be configured to assign priority tocertain optimization steps. Such prioritizing of image optimizationsteps may allow the system to reduce the processing time. For example,the image processing software may be configured to optimize theresolution of an image and then optimize the aspect ratio. Sincedisplays on handheld devices have relatively low resolutions, optimizingthe resolution involves reducing the number of pixels in the image to bedisplayed, and thus the number of bytes in the image file. Optimizingthe aspect ratio step may then involve processing far fewer bytes ofinformation. As further example, if the image processing involvesselecting a portion of the image to be presented as well as resolutionand aspect ratio adjustments, the step of selecting a portion of theimage may be performed first since this will leave a smaller imagecomprising far fewer bytes of information that needs to be processedduring resolution optimization.

In an embodiment, the entire image, optimized only to suit thephysician's handheld device display resolution limit, may be firstdownloaded to the physician's handheld device before processed andzoomed images are transmitted. This embodiment may be useful since inmany cases the physician will want to see the entire image first tounderstand the nature and content of the image, even though details ofinterest may be too small to be seen clearly. Typically, physicians willthen indicated portions of the image that they would like to view indetail (i.e., zoom images). The handheld device can then transmitrequests for zoom images to the data server. Then, instead of sendingprocessed images, the data server 131 can send a series of imageformatting commands to the handheld device enabling the device'sprocessor to display the portion of the image stored in memory thatcorresponds to the zoom request. Thus, the external processor performsthe image processing steps of determining the portion of the image todisplay, including setting the aspect ratio, but instead of sendinganother image, it sends parameters (e.g., memory locations or imagecoordinates) that the processor can use to quickly generate the desireddisplay from the image data stored in the handheld device's memory.

In an embodiment, predictive algorithms may also be used in the externalprocessor software to anticipate likely requests by the physician sothat preprocessing of image data can be accomplish, further shorteningthe time to respond to image requests, like zoom step requests. Forexample, in the situation where the physician requests a positive ornegative zoom step, the processor may perform part or all of a second(or more) positive or negative zoom processing step, anticipating thatthe physician may want to continue zooming in or out. Similarly, inresponse to a pan request, such as a request to show the next incrementof the image left, right, up or down, the processor may perform some orall of the next one or more pan image processing steps, anticipatingthat the physician may want to continue panning in the same direction.By anticipating the next image processing request, the externalprocessor can have some or all of the image processing accomplished whenthe next image request arrives, enabling it to immediately transmit therequested image.

While performing image processing in an external server is presently thepreferred embodiment, the invention should not be limited to theforegoing embodiments. It is well known that data transmission networkspeeds and processor speeds used in mobile devices are constantlyimproving. Therefore, with the advances in technology, the aboveembodiments may be applied to more complicated image processing andrendering techniques, such as including 3D renderings, 3D moviecreation, and multi-scale image optimization for example. It is expectedthat the processors used in mobile devices will eventually havesufficient speed and memory to be capable of quickly performing theimage processing steps discussed above. Therefore, embodimentencompassed within the scope of the claims includes conducting all imageprocessing on the handheld device itself. This is because when themobile device has sufficient processor capability it will beadvantageous to perform most or all of the image processing within thedevice to reduce the amount of data that must be transmitted back andforth between the mobile device and the external server. Moving theimage processing back into the mobile device may also result in fasterimage display and better utilization of the handheld devicecapabilities.

On the other hand, if data connectivity speeds improve to become fasterthan the processor speeds and capabilities of handheld devices, as iscurrently the trend with the introduction of 3^(rd) generation (3G)networks, complete image frames optimized for the handheld device couldbe collated on the server or other remote processor and made availablefor download via the faster data communication network.

Image processing algorithms may include defining one or more customtransform functions for each modality that defines various aspects ofthe original data file. Such a format interchange driver located in anexternal processor, such as the console 120, the data server, or in themedical device acquiring the data 150, may use data files or convert thedata into one or more other formats to allow easier transformation.Similar techniques may be used to transform data received from thehandheld device 150 back into the original image format for populatingmedical records or reconciling data received from the mobile device 150with data in the medical records.

Multiple variants of data format may be expected from multiple vendorsof medical devices, including medical imaging equipment, even thoughefforts to harmonize medical data formats are ongoing. To address thischallenge, the system may be customized upon installation to use thecommunication links that work with the particular devices installed inthe hospital network. The various embodiments are not tied to aparticular data format or communication protocol, enabling the system tobe customized to the data formats and network protocols of eachinstallation. Alternatively, a data format and communication protocoltranslator module or server may be included within the system to convertdata files and communications protocols to a common format and protocol.

In an exemplary embodiment illustrated in FIG. 4, Electronic MedicalRecords (EMR) system can be accessed in order to deliver patient medicalrecords to a physician's handheld device. An EMR system primarilycomprises text data that includes various standard data fields whichrecord the details of the patient's identity, basic demographicinformation (age, sex, height, weight, ethnicity, etc.,),patient-physician interactions, diagnoses, prescriptions, treatmentplans, etc. Thus, when a physician is reviewing a patient's currentdata, such as an ECG or diagnostic image, the physician may also need toaccess the patient's medical records, including information beyond whatthe console operator may have included in a consultation requestmessage. In other instances, the physician may need to review backgrounddata stored in an EMR system while, for example, performing rounds atone or more hospitals which he visits.

In the embodiment illustrated in FIG. 4, a data server 131 isconfigured, such as by connection to a hospital's wired and/or wirelessnetwork, so that it can communicate with an EMR server 113 or an EMRconsole 120. The EMR server 113 and console 120 may be physically orfunctionally integrated into the same equipment, such as a workstationwith a large memory that is configured as a server and coupled to thehospital's network. An EMR database typically will contain medical datapertaining to multiple specialties and sub-specialties. The data server131 may be configured to interface with EMR databases employingdifferent data formats by including the necessary translationcapabilities to receive data from the EMR database and translate thedata into a format that can be transmitted to and displayed by a mobiledevice 150.

Referring to FIG. 4, the data server 131 also may be configured to allowmobile devices 150 to access, such as upon a physician's request via themobile device 150, step 441, summaries of medical data, such as patientlists, step 431. When a list of patients is accessed, the physician mayselect a particular patient and a particular page or section of themedical records, step 442. Medical data of a patient may then beaccessed. This medical data may be further sortable by, for example, alist of specialties involved, chronological list of patient visits, oreven by major findings. The physician may then select an event or a fileto view, step 442. The data server 131 may then search through thepatient file and generate a summary of the patient's records pertainingto a particular visit, complaint, or specialty, and format this data fortransmission to the mobile device, step 432. The data to be sent to themobile device 150 may be customized and formatted on the data server 131to match the display characteristics of the mobile device 150. Themobile device 150 receives and displays the transmitted data, such assingle or multiple pages of summarized data, step 443. In an embodiment,the data may be displayed in a keyword format so that the physician mayquickly grasp the data of most interest, or click on specific key wordsto view a detailed listing of the related underlying patient-physicianinteraction record. The physician may then update the current datarecord or create a new one, perhaps with new observations or a newtreatment plan, step 443, which may then be uploaded back to the EMRserver, step 433.

EMR systems often include or are integrated with physicians' electroniccalendars and appointment schedulers. Oftentimes, physicians must addappointments or change their schedules. The data server 131 can becoupled to the physician's calendar in the EMR system so that thecalendar can be viewed and modified on the physician's mobile device150. In this embodiment, physicians may access their calendar or make achange to their calendar using their mobile device 150, step 444. Thephysician may also be able to make changes to the calendar. As withother communications, data summarizing the calendar change istransmitted the data server 131 by the mobile device using a cellulartelephone network. Depending upon the implementation and the sensitivityof the calendar change, such data may be encrypted or unencrypted duringthe transmission. The data server 131 receives and recognizes thecalendar changes and sends information to the EMR server 113 to updatethe calendar, step 434. The calendar update may then be reflected on theEMR system or the related physician or general office calendar basedupon the type of entry in the calendar and depending upon the EMR andcalendar systems implemented at the hospital.

This embodiment may also be useful when physicians need to reviewpatient medical charts prior to rendering an opinion or issuing an orderfrom a remote location. For example, if the physician is being consultedconcerning a patient discharge, the physician may need to review thepatient's medical chart prior to agreeing to the discharge. Theembodiment may also assist physicians in making follow-up appointmentsfor patients who require continued medical care. For example, patientsbeing discharged after a surgery in which an ImplantableCardioverted-Defibrillator (ICD) device was implanted in their chestswill require follow-up appointments for re-evaluation of their conditionand to confirm the proper functioning of the ICD device. In suchinstances, follow-up appointments and custom workflow procedures for thepatient may be created by physicians remotely by entering theappropriate information into their handheld device 150, step 445. Thedata server 131 receives the data from the handheld device 150 viacellular telephone or other wireless data networks, and send theappropriate messages (e.g., in the form of an e-mail with attachments)to the appropriate individuals and functions, including for example theEMR server 113, step 435. Appointment may be automatically generated inthe physician's calendar or an electronic reminder may be sent from thephysician's mobile device to his office personnel to schedule anappointment.

This embodiment may include software tools operating on the handhelddevice 150 and/or the data server 131 to facilitate the physician'stasks when the situation requires multiple actions as well asestablishing multiple follow-up events or appointments. For example, thedischarge of a pre-term birth patient may require a neonatologistreferral, a pediatrics appointment, an obstetrics/gynecology officeappointment, etc. Software decision tools can aid the physician bypresenting electronic fillable forms on the handheld device's screenthat remind the physician of all actions, orders and events appropriatefor the particular medical activity being addressed. For example, thehandheld device may present a form in which the physician first selectsfrom a menu the type of situation being addressed. If the situationinvolves discharge of a pre-term birth, the electronic fillable formpresented on the device may then present fillable blanks forneonatologist referrals, pediatric appointment creation, etc. Suchblanks may be filled by the physician using the keyboard entry or byselecting entries from drop down menus, for example.

In communicating medical information to mobile devices, the mobiledevice 150 may communicate with the data server 131 in multiple ways,including ways other than using a cellular network. Some modern mobiledevices are capable of switching between Bluetooth, WiFi, and differentcell phone carriers and networks depending upon signal availability.FIG. 5 illustrates the various communication systems that may be used bythe various embodiments in order to communicate medical informationto/from mobile devices 150, dependably and reliably, regardless of thephysician's location.

The software operating in mobile devices 150 may be configured toanalyze the available communication networks based on their signalstrength and other factors, including their security, cost, speed,reliability and signal stability, and switch their communication modefor accessing the data server 131, accordingly. The types of wirelessdata communication systems 560 that may be used include: the cell phonenetworks operated by cellular telephone service providers, such as EDGE,3G, CDMA, GPRS, and GSM networks 560; any of a variety of WirelessEthernet networks 540 that are being implemented within buildings,airports, hospitals, and commercial establishments, such as WiFi, orIEEE 802.11B, G, or N; 540; and Bluetooth links that may be establishedwith a local console 550. Additionally, some physicians may be equippedwith a satellite telephone, such as an Iridium handset, so that data mayalso be communicated via a satellite communication link via a satellite570. Of course, the physician's mobile device 150 may receive calls fromconventional telephones 590, such as a telephone positioned next to orwithin a hospital console 120.

In the normal case of data communications via cellular telephonenetworks, the message data will travel wirelessly between the mobiledevice 150 and the nearest cell tower 560. The cell tower may beconnected via wired or wireless networks reaching back to a networkcenter which may transmit the data via conventional telephone lines. Thedata message may then be transmitted to the data server 131 via theInternet 510 through an Internet server (not separately shown) that islocated near or remote from the cell tower, depending upon the serviceprovider's network set up.

In the case of a WiFi type wireless data transmission, the mobile device150 establishes a wireless communication link with a WiFi transceiver540. Typically, the wireless transceiver 540 is coupled to a localInternet server 520 which is connected to the Internet 510. In someinstallations, the WiFi transceiver 540 may be connected to the Internetserver 520 by way of an Ethernet via an Ethernet hub 530. To send amessage to the mobile device 150, the data server 131 sends the messagevia the Internet to the local internet server 520 which transmits themessage from the WiFi transceiver 540.

A Bluetooth wireless connection may be convenient for physicians workinginside an office near a local console but shielded from cellulartelephone or WiFi networks. Although a Bluetooth wireless data link maynot provide access to the Internet by itself, software on thephysician's mobile device 150 may be configured to allow the device tocommunicate with the data server 131 via the local console 550 providedthe console with the Bluetooth 550 linkage is connected either directlyor indirectly to the Internet, such as through an Ethernet router 530, alocal intranet server 520, and the Internet 510.

A satellite data link may be the only form of communication availablewhen a physician travels to remote locations on the globe. For example,a physician participating in Doctors Without Boarders may be practicingmedicine in Sub-Saharan Africa one day and in Indonesia the next. Yetthe full benefits of the various embodiments may be provided to suchphysicians using satellite communication links, allowing them to beavailable for consultations and use the full resources of the hospitalelectronic medical system regardless of their location. In suchcircumstances, data sent from the data server 131 may be sent via theInternet 510 to a SATCOM server 572 within the satellite serviceprovider. The SATCOM server 572 receives the message and reformats itfor transmission via satellite. The message is then sent via a groundstation antenna 571 up to the communication satellite 570 which relaysthe data down to the physician's mobile device 150. Communication fromthe physician to the data server 131 travels in a reverse path.

Since in many cases communications with physicians via their handhelddevices 150 will involve urgent matters, it is important to maximize thereliability of message communication. In an embodiment illustrated inFIG. 6, message may be sent via two redundant wireless techniques inorder to increase the likelihood of successful delivery on the firstattempt. In this embodiment, the same or similar message may be sentusing the cellular telephone system's SMS messaging system and datanetwork or electronic mail message system. This may be accomplished bysending the same or similar messages using both the data server 131 andthe SMS server 132 nearly simultaneously. Software in the handhelddevice 150 may then be configured to recognize redundant messages whenboth are received, so the physician is only notified once for eachmessage sent. The handheld device 150 may also be configured withsoftware to send back acknowledgement messages when an SMS ordata/e-mail message has been received. Reception of an acknowledgementmessage by either the SMS server 132 or data server 131 will providefeedback to the system regarding the availability and timeliness of thetwo networks so that subsequent messages may be sent over the morereliable link. In another embodiment, a preferred methodology fordelivery may be employed, such as HTML polling through the data network.If the server then detects that the message is not deliverable to thehandheld, it can automatically switch the mode of delivery such as, forexample, to SMS messaging. This logic can then be further extended fordelivery through e-mail in case an acknowledgement message is notreceived acknowledging receipt of the sent SMS message.

FIG. 7 illustrates an embodiment of software methods that may be used todeliver messages and medical data from a hospital console 120 to thephysician's handheld device 150 via a data server 131 and SMS server132. As with other embodiments, the user on a console may upload amessage for delivery to the physician handheld device, step 705. Thisdata is received by the data server 131, step 720, which notifies anHTML polling receiver that new data is available for transmission to thephysician, 725. If new data is available for transmission, 730, the dataserver 131 sends the data as an HTML message that includes the locationfor downloading an attachment or additional message details, 745. Thedata server 131 may then perform a loop waiting for new data fortransmission, 735. If the physician's handheld device is not acceptingHTML data transmissions, such as may be determined by failure of thehandheld device to request an HTML download within a certain amount oftime, the data server may send a notification of available data insteadby an SMS message, 740. To send the notification via an SMS message, thecontent of the notification, which can be an encrypted or coded stringof alphanumeric text which on decoding allows the handheld device todownload specific message data, is transferred to the SMS server 132which forwards the message via cellular telephone SMS systems, 755.

The console 120 uploads a new message and any data to the server 131,step 705. Data is received by the server 131, step 720. The server thennotifies a HTTP polling response section of its software that a newmessage has been received, step 725. Software operating on the handhelddevice 150 sends a HTTP query to the server, 770. The server 131responds to the query if new data is available, steps 730, 745. This ora separate follow up response contains the server memory (or IP address)location of the message and any data to the handheld device. Thislocation information, is decoded if it is in encrypted format orcompressed format, and processed on the handheld 150, step 780. Usingthis location information, the handheld device then requests andreceives a download of the new data from the location on the server,step 790.

If no new data is available on the server 131, the HTTP polling responsesection does not respond to the HTTP polling from the handheld device,but instead just waits for any new data to be uploaded to the server 131by the console 120, step 735. When no response is received from the HTTPpoll by the handheld device in a predetermined time period, step 775,the handheld device closes the current HTTP request and opens a new HTTPrequest, step 765, immediately thereafter or after a predetermined timedelay. This cycle of requesting a HTTP response and starting a newrequest if no response is received may be continued until new data isavailable on the server 131.

This continuous HTTP polling process also alerts the server 131 of theavailability of the handheld device 150 for sending and receiving data.In instances where a HTTP polling is not received by the server 131 fora predefined time period, step 740, the server can assume that thehandheld device is not available or easily reachable through the cellphone data network. The server 131 may then notify the handheld deviceof any new messages destined for that particular handheld device usingan SMS message through the SMS server 132, step 755. The server 131 mayalso update the status on the console 120 of the corresponding physicianas being unavailable, step 710, if either HTTP polling has been absentfor a predefined extended period of time, or if the SMS message, step755, does not result in a data download, step 790, by the handhelddevice in a predetermined time period. The SMS message sent by the SMSserver 132, step 755, may be decoded by the handheld device 150 whichmay then download the message from the server 131.

FIG. 8 illustrates detail steps of methods for transmitting medicalimages to a physician's handheld device 150 according to variousembodiments. The data server 131 and or the console 120 may perform anumber of illustrated processing steps prior to transmitting image datato a physician's handheld device 150. In a typical process, image datamay be received from a PACS system or other image source, 801.Additionally, information may be received from the handheld device 150regarding image sizing or selection, 800. The data server 131 obtainsthe image from the console 120 and determines its size and resolution,802. The console 120 may send the images directly from its memory, ormay direct the server 131 to directly access the hospital database orother image source 801. Also, the data server 131 obtains the screenresolution and size of the physician's handheld device, 803. Thisinformation may be obtained from a database of handheld devices assignedto current users, 813. This could also be achieved by the server 131querying the software on the physician's handheld device. If the imageto be transmitted will be the complete image, 804, then the longest sideof the image is matched to the dimensions of the handheld device screen,805 and the shorter side adjusted based on the aspect ratio of thehandheld screen. On the other hand, if the image to be transmitted is aportion of the complete image, 804, then the data server matches theshortest side of the selected portion of the image to the shortest sideof the handheld screen, and adjusts the longer side according to theaspect ratio of the handheld screen, 806. With any display of a givenresolution and a given image with a defined pixel density, a maximumzoom may be defined beyond which the image is either not recognizable,or the data presented in a clinical environment is not useful. Further,as selected by the handheld user, and also as may be dictated by thequality of the data network connection to the handheld device, a zoomfactor may be determined which optimizes the number of extra pixels perpixel of display delivered to the handheld device. For instance, if thehandheld display has a resolution of 200 pixels by 200 pixels, the dataconnection is very good, and the user chooses to have a 2× zoomcapability on the handheld, the server may deliver an image of 400pixels by 400 pixels. The data server then determines or obtains themultiplication factor for the handheld zoom capability, 807. The zoompreference of the user of the handheld device may be stored in adatabase file that may be accessed, 808. The larger the preferred zoomcapability of the handheld device, the larger the image file that shouldbe transmitted to enable that in-device zoom capability. With thisinformation, the data server 131 then multiplies the base resolution bythe zoom capability factor, 809 and sub-samples the image to match thescreen resolutions in both dimensions, 810. For example, if the originalimage includes 1200 pixels in the X dimension and needs to be resized todisplay 240 pixels in the X dimension, the server software will selectone out of every five pixels in the X dimension. Similarly, if theoriginal image has 1800 pixels in the Y dimension and needs to beresized to 320 pixels, the server software will select one in every fivepixels in the Y dimension. Once the image processing has been completed,the processed image is delivered to the handheld device as either adownloadable file or an image file delivered directly to the handhelddevice, 812.

While the embodiment method illustrated in FIG. 8 is described above astranspiring on the server 131, the embodiment method may alternativelyperformed on the console 120 in a substantially similar manner. In afurther embodiment, the embodiment method may be performed on aprocessor connected or integral to the medical imaging system that isthe source of the medical images (e.g., CT scanner, ultrasound imagingsystem, EKG system, etc.). To implement the embodiment method on eitherthe server 131 or directly on the medical imaging system computersoftware configured to accomplish the method can be loaded onto orintegrated into the functional software stored on the server 131 ormedical imaging system.

If the image file to be transmitted is a movie (i.e., a series of imagesto be viewed sequentially), the preceding process may be repeated forall of the individual frames, 811. Once the processing of all the frameshas been completed, the movie file is delivered to the handheld deviceas a downloadable file or as an image stream, 812.

Communicating medical data from the field to a medical facility andreceiving physician consultations in the field may also be important. Insome cases, a patient may be suffering from a condition that is toocritical to wait for transportation to a hospital before treatmentbegins. Also, because ambulances travel on roads, their arrival at thehospital may be delayed by traffic. In such instances, a critically illpatient may benefit from prompt treatment advice of a specialistphysician delivered to a location remote from the hospital. Such advicemay be provided quicker using the various embodiments if the physiciandoes not happen to be in the hospital at the time. Using the variousembodiments, the physician can review the patient's medical data andrecords remotely and guide the field emergency personnel on propertreatments for the patient. This capability may also be important whenimmediate attention to a patient is necessary in an air-ambulance. Forexample, in the case of a heart disease patient, communicating ECGrecords directly to a cardiologist can review and provide his findingsmay save the patient's life.

In an exemplary embodiment illustrated in FIG. 9, medical data collectedin the field may be transmitted to a medical facility before the arrivalof the field emergency personnel. For example, when emergency personnelarrive at a chest pain patient's location they may first conduct aninitial evaluation and then load the patient onto the ambulance fortransportation, step 902. Using medical devices in the ambulance 101,such as an ECG machine, the emergency personnel may monitor and recordthe patient's vital signs, ECG and obtain other medical data, step 903.Once such data is collected, the emergency personnel may transmit thedata to the destined medical facility using wireless networks, steps 904and 905. This data may also be transmitted to the medical facilityautomatically from individual medical devices in the ambulance usingwireless and wired networking technologies built into the equipment orthe ambulance. Such medical data may be transmitted to one or moredesignated data servers and then to one or more designated medicalfacility consoles, or directly to one or more designated medicalfacility consoles, using any available wireless and wired network,including, for example, cellular telephone data networks, WiFi networks,satellite communication networks or combinations of such networks, step906.

When the medical data is received at the hospital, that is in thehospital emergency room (ER) 910 an alarm may be presented on theEmergency Room (ER) console or an ER physician's mobile device, 911. Thedata may carry with it information regarding the criticality of themedical data being transmitted so the appropriate audio/visual alarm maybe generated to inform the hospital staff of the nature and urgency ofthe medical emergency. The ER physician may review the transmittedmedical data on the ER console or the physician's handheld device, 912.The ER physician may then either call the ambulance to convey hisassistance, step 913, such as buy using his handheld device, or createand send a message to another specialist physician for additionalconsult using the ER console or the physician's handheld device, step914. When an additional consult is requested, the consult requestmessage created by the ER physician is transmitted to one or morephysician mobile devices using one or more of the embodiments describedherein, step 915.

When a physician consult is requested, the transmitted medical data willthen be available to the contacted specialist physician 920 on his/hermobile device, step 921. In response, the specialist physician may thencall the ER, the ambulance or other hospital facilities (e.g., thecardiac catheterization lab) using the handheld device, 922. When a callis made in response to a consultation request transmitted do thehandheld device, the call back may be registered on the system, such asin the EMR system. Instead of calling, the consulting physician maycreate a message including his comments, orders for treatment plan, step923. Alternatively, the physician may contact other specialists, such asby forwarding the original consultation request message to the otherspecialists, for further consultation and feedback, step 924. The server131 may also be set up such that in instances where the consultingphysician is not available, or if a predesignated on-call specialist orphysician exists, then the message is routed to the appropriatephysician. Using the capabilities of the various embodiments, the otherspecialists may then either call the physician, the hospital or theambulance, or create electronic messages including their own comments,orders for treatment plan, step 925. All communications and calls fromthe various specialists contacted through this system may be registeredfor record keeping or billing purposes.

The various connections of medical devices and mobile handheld devicesto the Internet may be accomplished by one or more pathways dependingupon local network configurations available at the time ofcommunication. Also, data communications may be accomplished using anyof a variety of different telecommunications technologies and systemsthat exist or will be developed in the future. For example, data,instructions, commands, information, signals, bits, symbols, and pixelsmay be represented by voltages, currents, electromagnetic waves,magnetic fields, optical waves or pulses in order to communicate theinformation over the wired or wireless network. Data communication mayinclude transforming the data into packets with error correctiontechniques included for distribution over asynchronous or synchronouscommunication links as are well known in the art. Furthermore, thevarious illustrative devices, servers, modules, circuits, methods, andalgorithms described herein may be implemented as electronic hardware,computer software, or combinations of both. Software for the methods andsystems described herein may be stored on and reside in random accessmemory (RAM), flash memory, read only memory (ROM), electronicallyprogrammable read only memory (EPROM), erasable electronicallyprogrammable read only memory (EEPROM), hard disk drives, removabledisks, CD-ROM, or any other form of computer readable storage mediumknown in the art that will be developed.

Typical operations of the above described system and components will nowbe described illustrating how medical diagnostic and patient informationare transmitted to a physician via the physician's handheld device suchas a cellular telephone with a liquid crystal or superior display. Anoperator, or a system processor, selects one or more relevant sectionsof clinical data on a console to be sent to the physician's cellulartelephone. Typically, this will be data that requires the physician'sreview or data deemed relevant to diagnosing or treating a particularurgent condition. For example, in the case of a heart attack victim, anemergency medical technician in an ambulance may apply electrodes to thepatient's chest and initiate an ECG. In this example, the relevant datais the ECG trace and the console is the ECG system within the ambulance.

Once the data is selected on the console, the clinically relevant datais uploaded to a server. In the case of a console (e.g., a diagnosticmachine or workstation) this step may simply involve sending the datavia an internal network or via the Internet. In the case of a console inan ambulance, the data may be transmitted by wireless data link, radiotransmitter, cellular telephone, or any other wireless networkavailable.

The server to which the data is sent is programmed with executablesoftware to interpret the information and facilitate communications withthe physician's cell phone. In particular, the server can send a messageto the physician's cell phone notifying it of availability of theclinically significant data. This message may be in the form of an SMStext message, electronic mail or voice mail, or any other messagingtechnique available via the cellular network. Such a message may be sentwith or without the contextual information regarding the data. Insimplest form, the message may notify the physician that data isavailable for down loading from the server.

In response to the message from the server, the physician's cell phonecontacts the server and requests transmission of the available data.This may be initiated automatically by the cell phone in response to themessage, or upon prompting by the physician who may read the message andthen initiate the download by pressing a menu button. In an embodiment,the cell phone initiates the data download by activating a hyperlinktransmitted in the message from the server. Data downloading from theserver to the handheld may be accomplished by any data transmissionprotocol and system available via the cellular telephone network orother wireless networks accessible by the handheld device.

As described above, the downloaded data may include medical images,photographic or streaming video images, diagnostic data (which may bestreaming data such as an ECG trace), clinical data in text or tabularformat, or patient record data. Displaying such data on the cell phoneallows the physician to review the data anywhere and as soon as the databecomes available.

The physician is provided tools on the cell phone which allow him/her toassess the clinical data, annotate the patient's file, add opinions ornotes to the reviewed data, order procedures, further tests, ortreatments, and refer to others for consultation. Such tools may be inthe form of menu options with button selections, touch screen menus andtext entry via a keyboard on the cell phone.

The physician's notes, orders and/or requests (including requests formore data from the server) can then be uploaded to the server using anydata transmission protocol and system available via the wirelessnetwork. The server then forwards the physician's notes, orders and/orrequests to the appropriate network address. This address may be thepoint of data origination or other points in the hospitalinfrastructure. If the physician has requested additional data that isavailable on the server, such as display of another portion of a medicalimage, the server will prepare a data package in response and send it tothe cell phone in a reply message as described above.

Since the display size and processing power of cell phones are limited(especially compared to networked computers and workstations used toview and analyze clinical information within the hospitalinfrastructure), various components of the system may be configured toonly transmit the most relevant sections of patient data to thephysician's cell phone. Such relevant sections of data may beautomatically selected from data files by system servers, may beinputted manually by an operator (e.g., an ER nurse or an EMT in anambulance), or acquired directly from a medical device, or from adatabase.

In an embodiment, the console is configured with software to performprocessing on the medical data to reduce the amount of data that needsto be transmitted, increase the speed of data transmission, or reducethe amount of processing required on the handheld for download,preparation, and display of the data.

In an embodiment, the server is configured with software to performprocessing on the medical data to reduce the amount of data that needsto be transmitted, increase the speed of data transmission, or reducethe amount of processing required on the handheld for download,preparation, and display of the data. This processing may include, forexample, data compression on the received data.

In an embodiment, the server performs image processing on the receiveddata by sub-sampling the image to generate images for transmission thatappropriately suit the handheld device's screen resolution. Anembodiment of this process is illustrated in FIG. 10. This embodimentsolves three problems associated with displaying medical images on ahandheld device. First, a medical image 1010 can be quite large both inphysical size and data content. Yet, only a small portion of the imagemay be of diagnostic significance to a physician. Second, a handhelddevice has a small screen and typically that screen has a low resolutioncompared to displays on workstations and personal computers that may beused to view medical images in the hospital setting. Third, a handhelddevice has limited processing power given its power, size, andenvironmental constraints, and therefore cannot manage and display largefiles effectively.

In overview, the method allows a user to select an image portion 1011within the medical image 1010. This election may be by a pointer device,such as a mouse or light pen, used by an operator on a console or astylus moving on a touch sensitive screen, such as implemented in Palmpersonal digital assistants. The selected image portion is copied into anew image file 1012 which is sized to fit the handheld device display.Next, the new image file 1012 is reformatted to match the pixel densityof the handheld devices display resulting in a ready to display imagefile 1013. Finally, the ready to display image file 1013 is transmittedto the handheld device 1014 where it is displayed without significantadditional processing.

In operation, a user may implement an image display request byindicating a portion of a displayed image using keystrokes, menuoptions, or a stylus dragged on a touch screen of the handheld device.In response, the handheld device will send a display request to theserver using an available wireless data network, 1001. This request isreceived by the server via the wireless data network and supportingnetworks, 1002. Using the display request and the raw image data, theserver then determines the portion of the image data which matches thedisplay request, 1003. This may be accomplished by mapping thedimensions specified in the display request to the dimensions of theimage data to determine the requested selection. Additionally, theserver may consider the size of the handheld device display whendetermining the portion of the original image to be selected.

If the selected portion of the image is not the same size as thehandheld device display, the server will resize the image to fit thedimensions of the display, 1004. This may be a simple graphictransformation or a more complex image resizing process. The result thanis a selected portion of the display with a size that matches that ofthe handheld device display screen. Since most handheld devices have alower resolution screen than the resolution of a regional image, theserver may check for such a condition, 1005, and reformat the selectedimage to match the pixel density to the handheld display resolution,1006. By performing this reformatting operation in the server, thesystem avoids overwhelming the processor of the handheld device andspeeds up the image rendering process since the server processor is muchfaster than that of the handheld.

At this point the image is ready for transmission to the handhelddevice. In most applications, the server will encrypt the selected andprocessed image data prior to transmission, 1007. Finally, the servertransmits the encrypted image data to the handheld device, 1008. Thistransmitted image is received by the handheld device where it isdecrypted and displayed, 1009.

Using this basic methodology, the handheld device and server can worktogether to provide the zoom capability to facilitate the physician'sanalysis of complex medical images. Referring to FIG. 11, a compleximage may be loaded to the server for transmission to the handhelddevice by an operator at a hospital console, 1100. The loaded image issaved to the server, 1101. The availability of the image is alsotransmitted to the handheld device as previously explained, which canresult in the device requesting download of the image, 1102. In responseto this request, the server may deliver the entire image scaled in sizeand pixel density to match the handheld device resolution, 1103.

The physician may review the entire image on the handheld device andusing keys, menu options or a stylus drawing on the device display,highlight an area of the image for closer inspection, 1104. In anexample where the handheld device has a touch sensitive display screen,the physician may highlight the area for inspection by drawing arectangle on the screen with a stylus. In another example, a rectangleor square, corresponding to the shape of the handheld display aspectratio, may be generated around a region chosen by the handheld user. Inresponse to an image portion selection by the physician, the handhelddevice may send an image selection request to the server, 1105. In anembodiment, this request may be in the form of coordinates on the image,such as the coordinates of the upper left corner and a lower rightcorner of the desired display rectangle. While waiting to receive a newimage, the handheld device may display an in-process icon, symbol orimage to let the physician know that the system is working on generatingthe requested display.

The server may also receive requests to process and transmit a selectedzoomed image from an operator on a console. For example, a nurse at aconsole may determine that only a portion of a medical image will be ofinterest to the physician, such as may be the case of an X-ray of a limbwhere only the region containing a fracture is diagnosticallysignificant. In this example, the nurse can select the portion of theimage containing the fracture, such as by using a mouse or light pen,and direct the server to transmit the selected portion to thephysician's handheld device. In a similar manner, others with access tothe image or the server, such as an administrator or a supervisor withaccess to the server, may perform the image sub-selection operation.

Upon receiving the image request from the handheld device, the servercorrelates the parameters in the request to the original image file,1107. This may be accomplished by mapping the received coordinates tothe image dimensions. Such image requests will typically be made in asequence of zoom-in requests as the physician drills down into the imageto review particular details. Therefore, the server may make use ofcoordinates of previous image requests in order to correlate the newrequest against the original image, 1108.

Once the server has determined the portion of the original image to bedisplayed, it calculates the best fit of the selected image portion tothe handheld device display, 1109. and doing so, the server may callfrom memory information regarding the handheld device's display size,aspect ratio and pixel density/resolution, 1110. Using this information,the server determines the number of pixels within the selected portionof the original image and the number of pixels that can be displayed onthe handheld device, 1111. In an embodiment the server then sub-samplesor interpolates the image data in order to obtain twice the number ofpixels as needed to fill the handheld device display, 1112. In anotherembodiment, the server may sub-sample or interpolate the image data inorder to obtain the same number of pixels as needed to fill the handhelddevice display. Finally, the server sends the reformatted image to thehandheld device, 1113, which receives and displays the image, 1114.

This process of calculating a selected portion of the image andgenerating a display compatible with the handheld device display is usedfor panning motion as well as zooming. To pan, the user may press anarrow key or tap on a side of the display with a stylus, for example.The handheld device can calculate coordinates that corresponds to thenext image frame to the left or right, up or down, depending upon theindicated motion of panning. These coordinates are transmitted to theserver in an image request, after which the server processes the requestin the above described manner in order to transmit the desired imageportion to the handheld device.

In another embodiment, where a quicker response may be desired, thehandheld displays the previous unzoomed image, and allows the handhelduser to zoom in on another portion of the image, thus providing the sameend result as panning, while enhancing the accuracy of this process.

Using similar processes, the server can transmit and the handheld devicecan display moving images as illustrated in FIG. 12. Examples of movingmedical images include fluoroscopy, ultrasound images, ECG and EEGtraces, and video images (e.g., video images of a victim or an injury).An operator on a hospital console may select a movie file (e.g., a DICOMimage file) for transmission to a physician's handheld device, 1200. Theconsole or server may then obtain all frames of the selected movie filefrom a database, 1201, 1202. Then for each Frame within the movie file,the server processes the image data to optimize it to the resolution ofthe handheld device display, 1203. For example, the server maysub-select pixels in order to create an image file with two times thenumber of pixels that will be displayed on the handheld device. If thehandheld device has requested a display of a zoomed image (i.e.,selected a portion of the movie file for display), the zoom imageprocessing steps illustrated in FIG. 11 maybe performed, 1204. When eachframe within the movie file has been reformatted to match the handhelddevice display, the processed frames are assembled into a single file,such as an MPEG or AVI file, and transmitted to the handheld device,1205. The user may select a portion of the image for closer inspection,such as by using a stylus as described above, 1206. In that case, thezoom the process scribed above with reference to FIG. 11 is performed,1207. The revised moving image file is then transmitted to the handhelddevice, 1208, which then displays the moving image, 1209.

The server may have the dimensions and display characteristics of thephysician's handheld device stored in memory, such as recorded duringinitial installation, or obtain these upon the handheld devicelogging-in to the server, or at some other time. Alternatively, theserver may receive such technical specifications as part of a displayrequest from the handheld device. In another alternative, the server maysend a message requesting the handheld device to send its displaytechnical specifications. For example, the server may request thehandheld device's display properties in response to receiving a displayrequest. The display characteristics may include the number of pixelsthat can be displayed, the physical size of the screen, and the numberof color bits of information that can be displayed.

In determining the optimal resolution for each image transmitted to thephysician's handheld device, the server may use predictive algorithms,such as described herein.

In addition to generating resolution optimized images, the server mayalso perform three-dimensional renderings of three-dimensional datasets, thereby allowing the physician to view three-dimensional imagedata on his/her handheld device. Such renderings of three-dimensionalimage data may be in the form of rotatable two-dimensional slice images,or isometric renderings, or movies where the isometric rendering isrotated by a given angle frame to frame. As with the other imageprocessing methods described above, the server firsts creates arendering of the selected three-dimensional data and then reformats therendering to match the size and resolution characteristics of thehandheld device display. Using similar methods applied to eachthree-dimensional data set over a sequence in time, the server cangenerate a time-based sequence of three-dimensional renderings (whichmay be referred to as a four-dimensional rendering) for display on thehandheld device. Similar techniques as previously described may beapplied to allow the server to process and render the three dimensionaldata, with the control for the 3-D rendering and data management toolsavailable on the handheld.

In an embodiment, the server may receive a real-time stream of clinicaldata, such as an ECG trace, or image data, such as an ultrasound imageof a heart, and using methods similar to those described above withreference to FIGS. 10-12, process and transmit display-optimized imagesto the handheld device in near real time.

The transmission of moving image data to a handheld device, whether inreal-time or from stored movie files, must overcome technicallimitations that may vary from time to time and from device to device.For example, the transmission rate may be limited by the connectionspeed and bandwidth of a particular cellular telephone connection. Asnoted above, handheld devices may differ in their display size,resolution and refresh rate, as well as the devices processing speed,available memory and communication bandwidth. The connection speed andtransmission bandwidth of a cellular telephone connection will dependupon the signal strength and interference which will vary from place toplace, as well as the delivery techniques and processes utilized by thecell phone service provider. Also, these transmission characteristicsare likely to change as the handheld device moves within and acrosscellular zones, as will occur if the user is in a moving vehicle.Transmitting images at too high a frame rate for either the handhelddevice or the available communication link will only generatetransmission errors and provide no improvement in display. Toaccommodate such variability in transmission while providing a usefulmoving display of moving medical images, the server may implement aframe buffering method like that illustrated in FIG. 13. In this method,both the individual frames and rate at which frames are transmitted (the“frame rate”) are optimized to match the handheld device's displaycharacteristics and present connection speed.

Referring to FIG. 13, image data from a data file or from a real-timesource are obtained by the server, 1302. In the case of a movie file inmemory, all image frames may be obtained from memory and stored on theserver for processing. In the case of a real-time data source, a groupof frames may be selected at a time for processing with the restbuffered in memory. The server then performs the image resolutionoptimization methods described above with reference to FIGS. 10-12 togenerate a sequence of optimized image frames, 1304.

Simultaneously, the server determines the best (or an acceptable) framerate for transmission of images, 1303. This determination is based uponthe communication connection speed and bandwidth, the handheld devicedisplay resolution, and the handheld device display refresh rate. In anexample method, the server may determine the frame rate as the lowest of(a) the display resolution along with any zoom factor the user may havethe facility to choose, and the desired display frame rate; i.e. theeffective desired data rate, and (b) the actual data transfer rateavailable through the network to the handheld at that point in time. IfMPEG compression of image frames is desired, the MPEG compression factoris considered in the frame rate determination also.

With the best frame rate determined, the server sub-samples theoptimized image frames to select those to be delivered to the handhelddevice at the selected frame rate, 1305. This process may involveselecting a fraction of the frames for transmission, such as every otherframe, every third frame, three out of every five frames, etc. Finally,the server delivers the selected frames to the handheld device as asingle file or as a streaming file, 1306. In this transmission, theserver will also inform the handheld device of the selected frame rate,such as in a message header or as a separate data element, so thehandheld device can display the frames at the appropriate rate as amovie file or streaming video, 1307.

Since the data transmission rate of the communication link is likely tovary, the handheld device and the server may exchange information toenable the server to determine the current connection speed for use indetermining the best frame rate, 1308. This may be accomplished by thehandheld device periodically reporting back the number of lost bits orthe error rate detected in received messages. Alternatively, the servermay periodically send the handheld device a message containinginformation that allows the handheld device to determine the connectionspeed. In a third alternative, the server may send a message string ofknown length that the handheld device promptly resends back to theserver allowing it to measure the transmission rate and the number oferrors in the message. Other well known methods for determining datatransmission speeds of a communication link may also be used.

In the case of a real-time data source, the process illustrated in FIG.13 will continue to be performed on blocks of image frames buffered inthe server in order to provide a near-real time, near-continuous streamof images at an optimized frame rate with optimized size and resolution.In order to accommodate changes in connection speed that may occur ifthe handheld device is moving within or between cell zones, the serverand handheld device may periodically (such as every 10 seconds) exchangeinformation on the connection speed so the server can update theconnection speed and, if necessary or possible, change the best framerate used to transmit images. For example, if the physician is initiallylocated where there is low signal strength and/or high noiseinterference (in a “bad cell zone”), the real-time display may appearjumpy as the best frame rate may be lower than the display's refreshrate. Then as the physician moves to a location with better signalquality, the real-time display may appear smooth as the best frame rateincreases, reaching a maximum at the display's refresh rate.

In an embodiment (illustrated by the dashed arrow in FIG. 13), theserver may shift the sub-sampling function 1305 to the console, or evento the imaging unit providing the real-time data stream. In thisembodiment, the server determines the best frame rate, 1303, such as byusing the methods described above, and then sends the frame rateinformation to the console or imaging unit. The console or imaging unitthen samples the real-time data stream to select data or image frames atthe specified frame rate for transmission to the server. The server thenperforms image resolution optimization on the receive frames, 1304, andtransmits them on to the handheld device, 1306.

In addition to accepting information from an operator, the console maybe configured to accept commands from the operator to select, designateor access particular medical data for communication to the physician'scellular telephone. As an example, the console may include tools toallow the operator to view clinical data, dynamic data (e.g., an ECGtrace) and image data (e.g., an X-ray or ultrasound image) and select(e.g., by using a light pen, pointing device (i.e., mouse) and/orkeyboard) a portion for transmission to the physician. In anotherembodiment, the console software may be capable of receiving datarequests from the server, based on which the console may queryappropriate devices or databases and make available such data to theserver.

In various embodiments, the console, server and handheld device areconfigured with software to monitor the delivery of messages,accommodate disruptions and delays in the delivery of messages, and keepan operator on a console updated on the status of messages. Thisfunctionality is important in many medical situations in which responsetime is critical, such as in the case of a patient potentially sufferinga heart attack. Cellular telephone networks in certain geographicalareas are notoriously unreliable and physicians may be in and out ofcell phone contact. To address the criticality of reaching a physicianusing an unreliable network, the console, server and handheld device mayrepeat message transmissions periodically until a response is received.Also, if the physician is unavailable or fails to respond, the user onthe console can be notified so another physician can be contacted. Anexample of such methods is illustrated in FIG. 14.

Referring to FIG. 14, the user on a console may designate the importanceof a particular message, 1401. The importance of a message may determinethe number and frequency of delivery attempts and wait times used by theconsole and the server. It may also determine any internal reminder setups available on the handheld or console software. For example, routineand non-emergency messages may be designated with low importance,signifying to the console and server software that long wait times canbe accommodated and retransmissions of undelivered messages can be madeon an infrequent basis (e.g., once per hour), or even done away with.Conversely, if a message is related to a medical emergency situation,such as a heart attack victim being transported in an ambulance, theconsole operator may designate it as a high priority message, signifyingto the console, server, and handheld software that long wait timescannot be accommodated and retransmissions of undelivered messagesshould be made very frequently (e.g., once per minute) until a responseis received.

The importance of the message may set the response wait time accordingto rules stored in the console, or server, or the operator may manuallydefine the required response wait time, 1402. This is the time that cantranspire before the console generates an alarm to notify the consoleoperator that the message may not have been delivered or the physicianmay not be available or able to respond, 1403.

Message delivery importance parameters may also be set by a systemadministrator or other super-user according to hospital policies, 1405.Such policies may provide a maximum response time for physicians for oneor more importance levels designated to each message or to a class ofmessages, after which other communication methods will be tried or otherphysicians contacted. Alternatively, the policies may set importanceparameters for each of number of different medical circumstances, sothat the importance parameter depends upon the nature of thecommunication and/or patient treatment situation. These importanceparameters may also govern how many reminders are sent to or initiatedon the handheld device to remind the physician, and the frequency ofsuch reminder indications.

The server 130 receives the message performance information anddetermines the appropriate message repetition and reminder rates (i.e.,time to wait before repeating a message transmission or sending areminder) that should be implemented, 1406. The server delivers theprimary notification message to the handheld device, such as by postingan HTML polling or sending an SMS message, 1407, and begins a timer. Ifno response is received from the handheld device, which may be in theform of a request for the relevant data associated with a message,within the appropriate response time period, the server 130 willretransmit the message or send a reminder message to the handhelddevice, 1409. This process of waiting and retransmitting/reminding maycontinue a predetermined number of times, with the number of repetitionsdetermined by preset policies or based upon the importance of themessage.

When the handheld device receives a message, it may activate a ring,vibrate, activate the display, or otherwise notify the user, 1408. Thehandheld device may also respond to the incoming message, 1410. Suchresponse may be a receipt acknowledgement response (such as an SMSResAck message), an automatic response generated by the handheld device,or a message generated by the physician. In an embodiment, the handhelddevice may request and wait for an acknowledgment of its message, and ifno acknowledgement or response is received within a predetermined waittime, retransmit the response message, 1414.

Upon receiving a response from the handheld device, the data server 130will relay the response to the console or inform the console that themessage has been successfully delivered to the physician's handhelddevice, 1411. In response, the console may report the status of themessage delivery to the operator and/or stop the message tracking timer.In an embodiment, the server 130 will also send an acknowledgement backto the handheld device, 1413.

If the server 130 determines that the HTML page holding the data for thephysician has not been polled within a predetermine amount of time(determined based on policy or the message importance), step 1415, theserver may send an SMS message to the handheld device and notify theconsole 120 of the changing in message methods, 1416.

If the server receives no response to any messages within apredetermined amount of time and/or a predetermined number of deliveryattempts (with the predetermined amount based on policy or the messageimportance), the server 130 will notify the console and may change thephysician's status to unavailable, 1419. In response, the console 120may notify the operator of the message delivery failure, such as bymeans of a display, the sounding of an alarm or tone, or both, 1417.Alternatively, the console may determine or suggest to the operator thatanother physician to be contacted, in which case the process illustratedin FIG. 14 may be repeated. In instances where the handheld does receivethe message and the physician fails to respond within the stipulatedtime period, the handheld software may create a similar alarm to warnthe physician that the waiting message requires a follow-up.

In an embodiment, the system is configured with software programming ofthe server, console or both server and console working together, toreview clinical data and automatically recognize clinically significantpatterns that should be brought to the attention of a physician. Suchpatterns may be a single factor, such as a particular test result or apattern in an ECG trace (e.g., a fibrillation pattern), or a patternamong two or more different data elements. The diagnosticallysignificant pattern may simply be the portion of the data that containsinformation that may be of interest to a physician. For example, thesystem may automatically recognize portions of an ECG trace that containrelevant data, and reject portions (e.g., individual electrode traces)that have no relevant data. As another example, the server may beprogrammed to recognize portions of an X-ray image containing bone andtissue, and ignore portions that contain no image data. The server orconsole may further be programmed to fetch other relevant data, such aslab results, or previous ECG studies, based on such auto-detectionresults.

In an embodiment, the automatic recognition capability of the server,console, or server/console combination displays recognizeddiagnostically significant patterns to an operator on the console. Forexample, the system may display an ECG on the console and when adiagnostically significant pattern is recognized, shade, box, color orotherwise highlight the pattern on the display for the operator. Usingsuch tools, the operator can select the identified pattern fortransmission to the physician's cell phone. Thus, the system toolsprovides a semi-autonomous selection function where the system guidesthe operator to data of potential significance, but it is the operatorthat determines what is sent to the physician's cell phone.

In an embodiment, the data selection process can be fully automated. Inthis embodiment, upon detecting a diagnostically significant pattern,the server, console, or the server working in concert with the consolemay automatically select relevant sections of the patient data fortransmission to the physician's cellular telephone. This automaticselection may be based upon the same criteria and methods used torecognize diagnostically significant portions. Alternatively, theautomatic selection may be based upon other criteria. For example, theserver may select portions of an ECG trace before, during and after arecognized diagnostically significant portion so that the physician canview the data before, during and after the recognized event, such aswhile reviewing a Holter monitor output.

Medical data gathered and considered by the system for transmission tothe physician's cell phone may come from a number of different sourceswithin the hospital, within emergency vehicles, within doctor's clinics,and within the patient.

One source of data is the medical database of the hospital where patientrecords are maintained in electronic patient record databases. Medicaldatabases may also retain large data files associated with prior testsand medical images. Nonlimiting examples of such patient databasesinclude: an electrocardiogram database; the hospital's electronicmedical records database; an image database (which may include X-Ray, CTand MRI image data); an ultrasound image database; and a PACS database.Quite frequently such repositories of medical data records aremaintained in electronic format in computer readable storage accessiblevia server connected to the hospital's network system. Such databasesmay be queried through standard database interfaces defined in suchstandards as DICOM or HL-7, or custom interfaces may be needed for suchcommunication.

Another source of data will be data entry consoles and workstation,where nurses, doctors and technicians can enter patient data (bothbiographical and medical data) directly. An example of such sources arecomputer terminals in the emergency room for entering patientbiographical information and recording vital statistics like bodytemperature, pulse rate, blood pressure, symptoms, etc. Typically suchconsoles and workstations are connected to a hospital's network. In somesituations, the console is integrated with or also functions as a serveron the hospital network.

Medical diagnostic devices may also be sources of data. Non-limitingexamples of medical devices that may be sources of medical data include:electrocardiogram (ECG) equipment; electroencephalogram (EEG) systems;X-ray and fluoroscopy equipment; ultrasound imagers; computer tomographyimaging systems; magnetic resonance imaging systems; positron emissiontomography imaging systems; cardiac pacemakers and ICD interrogators;and automatic blood pressure and pulse rate monitors. Such medicaldiagnostic equipment may be located within the hospital and connected tothe hospital's electronic network. The devices may also be remotelylocated, such as in a doctor's clinic or within emergency responsevehicles (e.g., ambulance or helicopter) and transmitting data viawireless, cellular telephone, Intranet or other communication network.Some medical diagnostic equipment include as part of the system aworkstation computer that is physically integrated into the equipmentand can be connected to the hospital network, such as DICOM based PACSconnectivity on ultrasound imagers. Other diagnostic equipment may beconnected to a computer or workstation which is connected to thenetwork, with the computer programmed to receive data from the medicaldevice and store and/or transmit data via the hospital network.

Medical data may also come from medical devices implanted in orpositioned on a patient. Non-limiting examples of such medical devicesinclude: cardiac pacemakers; Holter monitors; portable blood pressureand pulse rate monitors; core temperature thermometers; and implanteddefibrillators. Such devices may require a wired or wireless dataconnection to transmit their data to a system interface for transmissionon to the hospital or the console.

Each data source and the operator console may be connected via networksthat are wired (e.g., Ethernet), wireless (e.g., WiFi, Bluetooth),optical (e.g., infrared), or combinations of these three well knownnetworking technologies. In the case of consoles and diagnosticequipment located within an ambulance, the data link may be any wireddata link available, including WiFi, Bluetooth, cellular telephonenetwork, satellite data link; satellite telephone, and FM radio.

In various embodiments, the consoles are configured via software and/orsecurity devices to limit access to authorized individuals. Any of wellknown security mechanisms may be used, including for example,recognition of a user's password, fingerprint, face shape, palm print,voice, and/or iris pattern, or a combination of one or more of thesetechniques. Additionally, the criticality or security level of uploadeddata types of data can be manually or automatically defined.

In addition to encrypting data, known methods may be used to transitmedical data with error correction and protection methods to minimizeerrors in transmission. In an embodiment, data is transmitted uses CRCchecksums. In another embodiment, the data is transmitted using forms ofauthentication, including use of certificates of authentication.

In an embodiment, during operation the server sends one or more messagesto the physician's handheld device notifying the device of theavailability of data. The message may or may not contain contextualinformation regarding the data. Such contextual information informs thedevice and/or the physician about the type of information available onthe server, such as whether this is a new transmission, a reply to arequest from the device, or some other source for the communication. Theserver may send the notification message to the handheld when data isready to be downloaded, or at one or more predetermined time-points.

In response to a message from the server that data is available, thehandheld device may send a message to the server requesting transmissionof the data. In response to this request, the server may transmit thedata immediately or at some predetermined time point. Also, the servermay send the entire data package to the handheld, or send a partialuploaded data to the handheld. A partial upload of data may beappropriate in circumstances where a wireless data connection is slowand/or unreliable. In such circumstances, the upload to the handhelddevice may be conducted in bursts, with one image downloaded at a time.Then, while the first image is being viewed by the physician the secondimage can be uploaded, and so forth until all images have been uploaded.

In an embodiment, the handheld device can transmit a message to theserver informing it that the data download was successfully received.The server may also obtain such a message delivery confirmation from thenetwork through which the notification is sent to the handheld. Forexample, a standard SMS delivery acknowledgement message may beforwarded to the server for this purpose.

In an embodiment, the server may send a reminder to the handheld ifrelated data has not been requested for download within a predeterminedtime-span. Additionally, the server may send additional dataavailability messages to the handheld device in an attempt to cause thedevice to request download of the data. After a predetermined amount oftime or a predetermined number of attempts to prompt the handheld deviceto download data, or a combination thereof, the server may notify theconsole and/or other predetermined points on the network. Suchnotification is important when a physician response is required in atimely manner. When the system is unable to upload the time criticaldata to the physicians handheld device within a set period of time,alternate physicians may be contacted or other contingency proceduresimplemented. Such Backup contact plans may be programmed into thesystem, such as the server or the console, for automatic orsemiautomatic implementation.

In an embodiment, the server may be configured by software toauthenticate the identity of the user of the handheld device prior tosending data to the handheld device. Such authentication may be inaddition to authentication accomplished by the handheld device itself.In such an embodiment, if the user of the handheld device will firstauthenticate himself/herself to the device in order to begin datacommunications with the server, followed by an authentication exchangewith the server in order to begin receiving patient information. Suchuser authentication methods may include, for example, a password whichmust be inputted on the handheld within a predefined time span followinga prompt prior to the data request being sent to the server. As withother security measures, such user authentication can include otheridentification parameters such as, for example, the handheld's serialnumber, the handheld telephone number, or other unique identifyingelements commonly found on cell phone handheld devices, a uniqueusername for the user, or a permutation or combination of theseidentifiers.

In various embodiments, the medical data transmitted to the handhelddevice may be information enabling either qualitative or quantitativeanalysis. For example, information suitable for qualitative analysis mayinclude X-ray and ultrasound images, while information suitable forquantitative analysis includes laboratory results, EKG's and vital signinformation. To assist the physician, the handheld device may includesoftware tools enabling the user to interact with the handheld device toperform quantitative measurements. Such tools may include simplecalculators, distance, time, area, and volume measurement tools,spreadsheet tools, and pattern recognition or other diagnosticrule-based aids. Similarly, the handheld device may include softwaretools to enable the physician to manipulate qualitative information,such as images, to arrive at qualitative judgments. The software toolsmay also include algorithms for automated recognition or detection ofcertain clinical conditions.

The software tools running on the handheld may be written in softwarethat can be run on multiple handheld operating systems. Such operatingsystems may include Windows Mobile, PocketPC, Symbian, Blackberry, orPalm. This software can also be implemented on any generic or alteredJava Virtual Machine (JVM) on any of the above or other operatingsystems where the handheld software may be developed using any industrystandard or other J2ME application development framework.

Alternatively, the software tools for aiding the physician may be hostedon the server with the handheld device programmed with a web browsertype interface for requesting analysis by the software tools anddisplaying the result. This embodiment allows the server to completemeasurements, analyze patient data and recognize patterns within thedata, with results sent to the handheld device in the form of text orgraphical displays. Since the server has much greater processing powerand memory, much more sophisticated tools can be implemented withresults generated much faster than may be achievable if the processingis performed on the handheld device. A user interface on the handhelddevice can receive inputs and display results in a manner so the user isunaware of where the actual processing takes place.

The server may further be configured with software so the display of theanalysis results is formatted on the server and transmitted to thehandheld device as an image. This embodiment enables the generation ofcomplex, mixed format and contextual displays, such as a differentdisplay of results depending upon the nature of the analysis or therecognized condition, without overloading the handheld device's memoryand processor. The server and handheld device may be configured withsoftware so that resulting displays are automatically downloaded to thehandheld device as they are completed by the server, or are downloadedto the handheld device on demand, such as in response to a user action.The server may also transmit displays providing structured data inputmemories, such as procedure order and prescription forms that thephysician can complete with text entry, menu selections or both.

In various embodiments, the software operating on the handheld deviceincludes functionality to record various physician orders, notesdiagnosis, plan of therapy, observations, prescriptions, andcombinations thereof that are relevant to patient care. Such recordedinformation may be typed text, handwritten text, or voice recordings, orcombinations of these three data types in order to provide the physicianwith a variety of data entry method alternatives. Such patient careinformation input into the handheld may be stored on the handheld deviceand then transmitted to the server through the cellular telephonenetwork. The transmission of such patient relevant information may be inany digital data transmission method, including for example electronicmail, SMS message, MMS message, WiFi electronic data transmission,Bluetooth, and satellite telephone data transmission.

In the various embodiments, the handheld device is configured withsoftware to be capable of displaying new messages and alerting the userof the arrival of new messages. The handheld device may include multipletypes of alerts, including but not limited to audio alerts, mechanical(vibration) alerts, and visual or text alert messages displayed on thedisplay screen. Such variety of alerts may be dependent upon theimportance of the incoming message.

In the various embodiments, the server and handheld device may beconfigured to control the conditions under which data is transmitted tothe handheld device. The server and handheld may be configured so thatcertain or all data is automatically downloaded to the handheld withoutuser actions. In an alternative configuration, the server and handheldmay be configured so that the data is downloaded from the server to thehandheld only upon an explicit action from the user, such as pressing akey or selecting a “receive” menu option. In another alternativeconfiguration, a subset of the data is downloaded from the server forpreview by the user, while the complete data set is downloaded onlyafter an explicit action by the user.

The handheld device may be configured with software to display anindication of a data download status, data download progress, datareview status, and/or data upload status.

The handheld device may be configured with software so that uponcompletion of data review and user input, the medical data is stored inthe handheld for later review. Such data may be stored in encrypted orunencrypted format.

The handheld device may be configured with software so that uponcompletion of data review and user input, the user input data isautomatically uploaded to the server, or is uploaded to the server afteran explicit action by the user, such as pressing a key or selecting a“send” menu option. The handheld device may be further configured soonly data that has been added or changed is uploaded to the server. Thehandheld device may also be configured so that data uploaded to theserver is sent encrypted with authentication information and errordetection and amelioration features.

The handheld device and server may be configured with software so thatthe uploaded data is forwarded automatically to the server, or is sentto the server upon demand from the original sending console. The servermay also be programmed so data is also distributed to otherpredetermined points, and archived on the server. Also, the server maysend the uploaded data to multiple databases, such as to all databasesthat relate to the patient (e.g., medical records, billing,prescription, etc.).

In the various embodiments, the server and/or console may be configuredwith software so that upon reception of data from the handheld device,the console signals the console user of the availability of thephysicians input. This software configuration may display certain textportions of the physician's response within predefined areas on the userinterface screen. Such an interface screen may be in any user interface,including for example, a graphical user interface, web browser page, acontrol panel display or a medical order form with dynamic fields. Forexample, the console display may be in the form of a control panel whichpresents the user with an organized display of patient data, patientmedical information and images, messages and requests transmitted to aphysician's handheld device, status of message transmissions, messagesand orders received from a physician's handheld device, and the statusof subsequent patient treatment or testing procedures.

While the foregoing system provides significant advantages for patientsand physicians, its use of public communication systems, includingcellular telephone networks and servers, requires special securitymeasures. Patient privacy must be protected under HIPAA and other U.S.laws, yet some of the information being communicated may need to bedecrypted by an intermediary server or sent unencrypted in order toenable data processing associated with communicating the entire file toan intended recipient.

FIG. 15 is a general system and process flow diagram of an exemplaryembodiment configuration of the system, wherein data is sent from acomputer or digital console 120, through an intermediary server 130, toa remote handheld computer 150. Data is generated or accessed by thesending console 120. The data is separated out into at least twoseparate parts, such as demographics and functional data 2101. As afirst example, if the data was a DICOM file with medical images (e.g.,X-ray or ultrasound images), the data may be separated into a firstpart, or header, containing the patient demographics data, including,for example, the patient's name, date of birth, and other personalinformation, and a second part that contains the raw images. As anotherexample, files containing the results of a requested test or procedure(e.g., an EKG or laboratory test) that include the patient's referralinformation (e.g., the patient's name, address, social security number,other identifiers, health insurance particulars, etc.) along with theresults may be separated into a demographics file containing thepatient's name, address and other personal demographic details, etc.,while the pure clinical data, such as the EKG, or lab results, areseparated into a clinical data file. Separated parts of medical data arealso referred to herein as “layers” or “data layers.”

Once the personal information has been separated from the clinical orimage information, the two (or more) parts of the medical data areencrypted with separate encryption keys. While the demographics layer isencrypted with one encryption key 2102, 2103, the data layer isencrypted with a separate encryption key 2104, 2105. Any encryptionmethod can be used to encrypt the various data layers, including, forexample, 128 bit public key encryption. Also, the various data layersmay be encrypted using different encryption methods or encrypted withdifferent levels of security. For example, medical image data which maypresent less privacy concerns when separated from personal demographicinformation may be encrypted with a less secure, but faster encryptionmethod, such as 32 or 64 bit public key encryption.

The separately encrypted data layers can then be sent to a server 130.This server 130, or any intermediary waypoint, only has the decryptionkey or keys useful for decrypting the data layer 2112. Thus, the server130 is unable to decrypt the demographics layer. If processing of thedata layer is required, the data layer may be decrypted on the server,2113, using the data layer key 2112. Data held in the data layer canthen be processed in the server in any way necessary for thecommunication system. A number of data processing operations may beperformed on some or all of the data within the decrypted data layer.For example, the data layer may be processed to select and/or compressmedical images, filter EKG signals, apply auto-detection to signals, orother processes in order to reduce the volume of data to be communicatedto a recipient.

Once the server has completed processing of the data layer, the servercan use a data encryption key to re-encrypt a portion or all of theprocessed data layer such that it is safe to transmit this data layerthrough any public or private network. In this step, the server uses adata encryption key whose decryption key is known to the destination,such as a physician's handheld device (e.g., a cell phone). This seconddata encryption key (or encryption/decryption key sets) may be the sameas was used to encrypt/decrypt the data layer before it was sent to theserver (2112), or it may be a different key or key sets that are sharedbetween the server and the handheld.

In various embodiments, the server processes some or all of the datawithin the decrypted data layer to facilitate communication of medicaldiagnostic and image data to a physician's handheld device (e.g., a cellphone). Due to the limited memory and processing power of handhelddevices like a typical cellular telephone, as well as the limitedbandwidth for transmitting data via cellular telephone networks, thecommunication system my communicate only those portions of the datalayer to be displayed or of interest to the physician. Thus, in a firstexample embodiment, the server may be programmed to process an imagewithin the data layer to select for transmission to the handheld deviceonly that portion of the image which will be displayed on the device. Inthis example, the server will decrypt the data layer using the datalayer decryption key, process the image to select the portion to bedisplayed, format an display image comprising the selected portion ofthe original image, encrypt the display image using a data layerencryption key (either the same key or a different key), and then sendthe encrypted display image as a data layer to the physician's handhelddevice. In such an embodiment, the server may receive data requests fromthe handheld device to process and transmit a new image selection fordisplay, in which case the server may perform the steps of imageprocessing, re-encrypting and transmitting a new data layer to thehandheld.

In a second example, the server may process an image within a decrypteddata layer in order to compress the file size of the image to facilitatetransmission to and display on the handheld device. Handheld deviceshave limited display resolution and limited processing capability. Toovercome such limitations, adjustment of the image resolution such thatit is consistent with the handheld device display capabilities andcompression of the resulting image data to reduce the amount ofinformation to be communicated via the cellular telephone network isperformed on the decrypted data layer by server. The server thenencrypts this processed and compressed image data into a new data layerthat is transmitted to the handheld device for decryption and display.

In a third example embodiment, the server may decrypt a data layerincluding an EKG data stream, perform pattern recognition processing onthe data stream, such as EKG diagnostic tools, and select portions ofthe EKG that contain diagnostically significant information. The servermay then encrypt the selected portions of the EKG and send the selectedportions to the handheld device as a new data layer.

In a fourth example embodiment, a physician may input into the handhelddevice search criteria or otherwise indicate the type of data to bedisplayed on the handheld device, which transmits the selection criteriato the server. The server can use the received selection criteria toselect from the decrypted data layer a subset or portion of the medicaldata to be sent to the physician's handheld device. The server thenencrypts the selected portion of the data from the data layer andtransmits it to the handheld device as a new data layer.

In a fifth example embodiment, the server, working in concert with theconsole, accesses and indexes historic data files or secondary datapertaining to a particular patient. On demand from the physician, suchhistoric data can also be delivered to the handheld device to allow thephysician to do a chronological comparison of data. In this embodiment,the server arranges the accessed data in unique formats that allow foreasy delivery, viewing and analysis on a handheld device. Thisembodiment provides intelligent tools on the server-console combinationthat can respond to data and circumstances to anticipate the physician'sinformation needs. For example, a server according to this embodimentcan be programmed to recognize an elevate ST segment in a patientmedical file and, working with the console, automatically ask for thepatient's blood cholesterol levels (and other relevant information) fromthe EMR system and make such information available on the physician'shandheld device without the physician having to specifically request theinformation. Such automatically accessed information may be combined inthe same display, cached in the handheld device for rapid display (e.g.,in response to a menu selection), or cashed in the server for rapidcommunication to the handheld device when requested by the physician.

In each of the foregoing example embodiments, the server selects andsends at least a portion of the processed data layer information andencrypted data layer. Thus, these embodiments enable a system server toperform processing on the data layer that would otherwise have to beaccomplished by the handheld device without risking disclosure of thedemographic data in the event the server is compromised.

The two layers of the source file can be maintained (i.e., stored inmemory) within the server with a common trace header. Alternatively, asillustrated in FIG. 18, a pointer 2401 to the file location of thesecond data layer 2402 may be embedded (e.g., a data entry) within thefirst layer 2401. This configuration allows the receiving handheld todecrypt the first layer 2400 to learn the pointer to the file locationof the second layer 2402, and then request the appropriate matchingsecond layer 2402 from the server by transmitting the associated pointer2401. As illustrated in FIG. 18, the demographic data layer 2400 may bestored in server memory 2403 in a database of demographic files 2404that is in a different file location or even on a physically separatememory (e.g., on a separate hard drive) from a database of data layers2405. This alternative file storage and data layer linkage configurationallows for complete blinding of the data layer (e.g., clinical data)from the encrypted patient demographics data. Thus, this alternativeadds an additional layer of security for data stored on the server, evenfrom persons authorized to access the server.

Referring back to FIG. 15, both (or all) data layers can then be sent tothe physician's handheld. The two or more data layers can be sent inparallel, or serially one after the other. Alternatively, one layer maybe sent first after which the handheld identifies and requests the otherlayer. For example, using the data configuration illustrated in FIG. 18,the demographic data layer 2400 may be sent to the handheld, whichdecrypts the data it to access the pointer 2401 and then transmits thepointer information to the server requesting that the associated seconddata layer 2402 be transmitted.

When the handheld receives an encrypted data file, it uses its datalayer key 2121 and its demographics layer key 2122 to decrypt both datalayers and then displays the information to the authorized individual.

In an embodiment, the demographics layer carries a header file thatidentifies a streamable data layer, such as a movie file as used inechocardiography, or a real-time EKG signal, either stored on or routedthrough the server. Upon decrypting the demographics layer, the handheldsends a request to the server to transmit the relevant data file as adata stream. The data file is then sent by the server to the handheld ina streaming format such that the handheld can receive and display thestreamed data. The streaming data file may be encrypted as it istransmitted.

The system and encryption methods can be made even more secure bydeleting the header file from the server after sending it to thehandheld, such that after the request for the second data layer isreceived and processed by the server, the original demographic data nolonger exists on the server. This option eliminates the possibility of apotential hacker monitoring the order of data transferred in order tomatch a demographics layer to a data layer.

The sending unit of the communication system may be any computing devicewith capabilities to process such data. The intermediary point may be aspecific server, a collection of various servers, or even a partlymanual process with human intermediaries. Also, the receiving unit(referred to sometimes as a handheld) may be a cellular telephone,personal digital assistant, laptop computer, desktop computer, anotherserver, or any other device or system with data processing capability.

FIG. 16 illustrates an aspect within such a secure system forauthenticating users. Medical data may be transmitted from aworkstation, console or medical diagnostic unit that may be located in arelatively public and busy area, such as an intensive care unit. In suchpublic or high-traffic, busy locations, a person with malicious intentmight be able to physically access the workstation, console or medicaldiagnostic unit. Also, the physician's handheld unit can be a cell phonebased system, in which case there is the possibility that the cell phonemay be stolen. If stolen, the software on such a handheld unit might becopied and installed on another phone in an attempt to mimic theoriginal phone. Therefore, an authentication system may be implementedto defeat such hypothetical attacks. An example embodiment of such asystem illustrated in FIG. 16 uses hardware as well as personalizedunique identifiers to authenticate and limit access to authorized users.

In an embodiment, the user logs onto the system with a unique user IDand password 2201. While the user ID and password may be conventionalalphanumeric strings known to the user, such data may also include otherunique high-security identifiers such as fingerprint or iris scan imagesobtained by a biometric sensor. The user ID data is combined with theunique identification of the particular console being accessed, whichcould be the name of the console, its IP address, the networkidentification of the computer, etc. 2202. The combination of the userID, password and console ID is sent to the server for authentication2203. The server carries a database of authorized users, passwords, andconsoles for the individuals authorized to log on to the system 2211,2212. The server compares the user ID, password and console ID data tothe authorized user database and, if there is a match, signals theconsole software to allow access to the user 2213, 2204.

Similarly, the handheld 150 user logs onto the handheld using a uniqueuser ID and password 2221. This user authentication information is thencombined with an identifier unique to the handheld device 2222 and thecombination is sent to the server 2223. Handheld unique identifier maybe the telephone number of the phone, a number separately stored on thehandheld in an undisclosed location and accessed internally by thesoftware, the IMEI number which is unique to each cell phone handset, orother such unique identifier. The server compares the receivedcombination data to the user ID and password list 2214 and theauthorized user list by phone number/device ID 2215 and authorizes thelog in to the handheld device if a match is obtained 2216, 2224. If theuser is authenticated, the server may send commands to the handhelddevice instructing it to allow the user to access the functions and dataon the device, as well as enable transmission of data to the handheld.If the user is not authenticated, the server may send commands to thehandheld device to disable data decryption algorithms, encrypt or deletedata stored on the device, disable some or all handheld functions,and/or inhibit transmission of data from the server to the handheld.

Other user authentication embodiments may include multi-level userpasswords for accessing or authorizing critical data, biometric scannerson the handheld (e.g., fingerprint or iris scanners), voice printmatching algorithms and other biometric signature matching equipment oralgorithms that can allow access to one or more layers of data on thesystem, console and/or handheld device.

FIG. 17 details an embodiment for the encryption key generation process.In the illustrated process, the data layer key or the demographics layerkey generation algorithms 2102, 2122 are shared only between the consoleand the handheld and are not available to the server, while the datalayer keys or key generation algorithms 2104, 2112, 2121 are availableto the console, server, and the handheld.

During system install on the console, the installation process 301installs the encryption key, set of keys, or the key generationalgorithms 302 in console memory. This encryption key, set of keys, oralgorithm which generates keys provides the encrypting demographics key2102.

Similarly, during system install on the handheld 2303, the processinstalls the key necessary for decryption or set of decryption keys,and/or the algorithm for choosing or generating the decryption keys 2304for the demographics layer and for the data layer. Thus, the server hasno knowledge of the encryption and decryption of the demographic layer.As mentioned above, the key used to decrypt data layers may be the samekey that is used to encrypt the layer originally (i.e., mirror keys), adifferent key.

The data layer encryption and decryption key generation/distribution mayemploy any well known public/private key architecture as are well knownto those skilled in the art. Alternatively, the data layer encryptionand decryption key generation/distribution may be a process asillustrated in FIG. 17, wherein the server supplies the data key 2320when the console log-in or boot up process occurs 2310, 2330. Further,although not shown in FIG. 17, the data layer keys used forcommunications between the console and the server may be different fromthe data layer keys used for communications between the server and thehandheld. Similarly, the encryption algorithms used forencrypting/decrypting the data layer may be different from theencryption algorithms used for encrypting/decrypting the demographiclayer.

The various keys used for encryption can be separately provided as asingle non-changing key, employ a time based look-up method similar toany one-time use key, or be dynamically generated by any known keygeneration algorithm. Further the encrypting key can be separate, whilea separate mirror of the encrypting key can be used to describe thedecryption key or process.

In operation of an embodiment of the system, the console ID is used togenerate the demographics key when data is available for encryption.Time-dependent, or time-independent variables, such as console ID, thetime and date the message was generated, and other random or semi-randomvariables can be used to seed an algorithm to generate the demographicskey 2102. A similar process can also be used to generate the data key2104, however, in which case, the methodology to decrypt such adynamically generated key is known to at least the server.

The separate data layer 2345 and demographics layer 2344 (andpotentially more layers) of the message 2342 are encrypted using therespective data and demographics keys and the results sent to theserver. As mentioned earlier, the unique header, a memory point, orother identifier for the data layer may also be embedded within theencrypted demographics layer to further blind the server at this stage.

When it receives the transmitted encrypted message, the server uses itsinternal data key 2104, or a complimentary data decryption key that maybe generated by a predefined process, to decrypt the data layer. Dataprocessing is performed on this decrypted data 2351 after which the datamay be again encrypted and stored. The encrypted data layer anddemographic layers are then sent to the handheld 2353, 2354. Asmentioned earlier, this last step can be broken into the server sendingthe handheld the demographics layer separately, with the handheld thenrequesting a specific separately stored file comprising the data layer.

The handheld receives the data layer 2360 and the demographics layer2361. The handheld obtains the demographic layer and data layerdecryption keys 2102, 2104, such as by recalling the keys from memory ifin a stored format within the handheld or dynamically generating thekeys using a predefined process. These decryption keys are then used todecrypt the respective layers enabling the handheld to display the datato the user in an integrated fashion.

In another embodiment, the foregoing methods for encrypting anddecrypting data are spread across multiple way-points and the data areseparated out into multiple layers, with each layer containing data thatis uniquely required to be accessible at one or more way-points, whilethe rest of the data remains encrypted. In this embodiment, eachway-point may have a decryption key unique to the data layer it mustaccess to enable its portion of the message processing and communicationprocess. For example, a message may be separated into a demographicslayer and data layer as described above, plus a message routing layer, aphysician action layer, and a record-link layer. In this example, themessage routing layer may contain private information required forrouting the files to the appropriate destination, such as the cell phonenumber of the physician's handheld which is required by a cell phonenetwork server to accomplish the communication. Further in this example,a physician action layer may include treatment, laboratory orconsultation orders, prescriptions, notes or diagnosis. Similarly, arecord-link layer may contain file record locators or memory pointersthat indicate the storage location(s) of the patient's medical recordswithin the hospital system. Each of these three additional layerscontain potentially sensitive information which may need to be accessedby different servers and data systems which do not require access to theentire patient data file being communicated. By selectively encryptingdistinct subsets of patient medical data and records, patient files canbe efficiently communicated over a semi-secure network without revealingany more information to each way-point server than is needed for theparticular processing accomplished at such way-point.

FIG. 19 illustrates an example embodiment in which the patient medicalfile 2500 is separated into three layers, a demographic layer 2501including personal information of the patient, a data layer 2502including clinical, image or diagnostic data that does not inherentlyreveal the identity of the patient, and a prescription layer 2503including information related to the patient's current and pastmedications. After the three layers are created by the console 2550,each layer is encrypted with a different encryption key. The data filethen may be routed to a prescription server 2551 which has a decryptionkey for the prescription layer 2503, but not for the demographic layer2501 or data layer 2502. The prescription server can then decrypt theprescription layer in order to perform prescription processingoperations on the data within that layer (such as update the patient'smedications or order medications to be administered). However, theprescription server is unable to access or display the encrypteddemographic layer 2501 e or data layer 2502 e. For example, theprescription layer data may be updated to reflect additional medicationsbeing administered or to order delivery of a new prescription. Forexample, the console may be located in the emergency room where patientintake is occurring, so the prescription server may update the datawithin the prescription layer to open a new prescription and/or recordadditional medications that may have been administered in the emergencyroom. Before the file is sent on from the prescription server, theprescription layer is re-encrypted using a prescription encryption key(either the same or a new key).

Next, the entire medical file may be routed to an image processingserver 2552 which can decrypt the data layer 2501, but cannot decrypt,access or display the demographic layer 2501 e or prescription layer2503 e. The image processing server 2553 can then select a portion ofthe image for display on the physician's handheld device 2553, forexample, which is then re-encrypted before the file is sent on to thehandheld device 2553.

The handheld device 2553 has decryption keys allowing it to decrypt,access and display each of the demographic layer, data layer andprescription layer, thereby reassembling the patient's medical file2500. Alternatively as a further example, the handheld device 2553 mayonly have the decryption keys for the demographic layer and the datalayer, leaving it unable to access or display the prescription layer.

In a further embodiment, data from a critical lab results database,medical images, physiological variable plotting (such as EKG andrespiration), recent prescriptions, and a summary of the patient'sprevious medical history are assembled into a message by the console,with each of these components forming a separate data layer of themessage. The complete assembled file can be forwarded to the physician'shandheld device through a server. The server may only have the keys todecrypt the physiological variable data and the images, while the otherdata layers are sent on to the physician's handheld in the mannerpreviously described without decryption on the server.

The physician's handheld device then decrypts all of the data layers anddisplays the data to the physician. Using the information, the physicianmay enter orders, issue prescriptions and/or set up a treatment plan.The handheld device may then reencrypt each of the data layersseparately, add a prescription/treatment plan/orders layer to thecollection of data layers, and send the assembled message back thehospital through the cellular telephone network server, along with arouting file which defines the routing of each of the data layers.

For example, the data layers, which may have measurements performed bythe physician attached, may be routed back to the database that archivessuch data files. The physician's orders and prescription may be sentback to the originating console for the attending nurse to takeappropriate actions. The prescription layer may be sent to theprescription processing system, for electronic processing of theprescription. A copy of the complete file may also be updated on thehospital's Electronic Patient Record system.

The specific message routing may be different in different hospitals, asdictated by standard work flow and local controls. Message routing andserver access to specific data layers may be established to a particularhospital's requirements when the system is initially installed.

The various embodiments ensure that even if a server is “hacked” oraccessed by an unauthorized operator, such intruders are unable toreassemble the patient demographics information and obtain access to theentire patient file. If intruders do gain access to a server, they canonly see images or EKG traces without any knowledge regarding to whomsuch data pertains. This provides greater patient protections thatspecified by HIPAA since HIPAA compliance has been based upon employeesand hospitals certifying that they will not leak patient data to whichthey have access. The various embodiments prevent hospital employees orhackers from being able to access and decrypt patient demographic data,so that only unidentified clinical data can be accessed.

The foregoing embodiments may be implemented in software operating onprogrammable processors, in hardware and in combinations of hardware andsoftware. In particular, encryption and decryption methods andalgorithms may be implemented specialized encryption/decryptioncircuitry according to methods well known in the encryption andtelecommunication arts. Further, software for accomplishing the variousembodiment methods may be recorded on any computer or processor readabletangible memory.

The foregoing description of the disclosed embodiments is provided toenable any person skilled in the art to make or use the presentinvention. Various modifications to these embodiments will be readilyapparent to those skilled in the art, and the generic principles definedherein may be applied to other embodiments without departing from thespirit or scope of the invention. Thus, the present invention is notintended to be limited to the embodiments described herein but is to beaccorded the widest scope of the following claims consistent with theprinciples and novel features disclosed herein.

1. A method for communicating a patient medical file of a patient, saidmedical file including personal demographic information, medical dataand a diagnostic image, the method comprising: separating the patientmedical file into a plurality of layers including a demographic layercomprising the demographic information and a data layer comprising themedical data and the diagnostic image; selecting a portion of the datalayer including at least a portion of the diagnostic image on a console;encrypting the demographic layer using a first encryption key;encrypting the data layer using a second encryption key, wherein thesecond encryption key is different from the first encryption key;sending the encrypted demographic layer and data layer to a server whichis capable of decrypting one of the encrypted demographic layer or thedata layer but not both; decrypting the data layer at the server;performing an operation on the decrypted data layer comprising selectinga second portion of the diagnostic image; re-encrypting at least aportion of the processed data layer including the selected secondportion of the image; and transmitting the encrypted demographic layerand the re-encrypted data layer to a mobile device.
 2. The method ofclaim 1, wherein re-encrypting at least a portion of the processed datalayer including the selected second portion of the image comprisesre-encrypting the at least a portion of the processed data layer with athird encryption key different from the first and second encryptionkeys.
 3. The method of claim 1, wherein: the operation performed on thedecrypted data layer further comprises formatting at least a portion ofthe second selected portion of the diagnostic image within the datalayer to match display parameters of the mobile device, andre-encrypting at least a portion of the processed data layer comprisesre-encrypting the formatted the diagnostic image.
 4. The method of claim1, wherein: the operation performed on the decrypted data layercomprises analyzing the contained data to recognize a diagnosticallysignificant pattern; selecting a diagnostically significant portion ofthe contained data; and re-encrypting at least a portion of theprocessed data layer comprises re-encrypting the selected diagnosticallysignificant portion of the contained data.
 5. The method of claim 1,wherein the operation performed on the decrypted data layer comprisesanalyzing an EKG trace to recognize a diagnostically significantpattern; selecting a diagnostically significant portion of the EKGtrace; and re-encrypting at least a portion of the processed data layercomprises re-encrypting the selected diagnostically significant portionof the EKG trace.
 6. The method of claim 1, wherein: the operationperformed on the decrypted data layer comprises assessing a criticalityof the patient based on data included in the data layer; and indicatingthe criticality within a message header or the processed data layer sentto the destination device.
 7. The method of claim 1, further comprisingreceiving a data selection criteria from the mobile device, wherein: theoperation performed on the decrypted data layer by the server comprisesusing the received data selection criteria to select a portion of themedical record of the patient, and re-encrypting at least a portion ofthe processed data layer comprises re-encrypting the selected portion ofthe medical record of the patient.
 8. The method of claim 1, furthercomprising: receiving the encrypted demographic layer and data layer ata mobile device; decrypting the encrypted demographic layer in themobile device using a first decryption key; decrypting the data layer inthe mobile device using a second decryption key different from the firstdecryption key; and displaying at least a portion of the decrypteddemographic layer and at least a portion of the decrypted data layer ona display of the mobile device.
 9. The method of claim 8, furthercomprising: receiving a user input on the mobile device associated withthe displayed portion of the diagnostic image; and sending a requestfrom the mobile device to the server requesting transmission of a thirdselected portion of the displayed diagnostic image based on the receiveduser input on the mobile device, wherein: the operation performed on thedecrypted data layer by the server comprises using the received requestfor transmission of the third selected portion of the displayeddiagnostic image to reformat the third selected portion of thediagnostic image to fit a size of the display of the mobile device, andre-encrypting at least a portion of the processed data layer comprisesre-encrypting the reformatted third selected portion of the diagnosticimage.